Publications by authors named "Lena Gunningberg"

65 Publications

Pressure ulcer risk assessment-registered nurses´ experiences of using PURPOSE T: A focus group study.

J Clin Nurs 2021 Jun 9. Epub 2021 Jun 9.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Aim: To evaluate the clinical usability of PURPOSE T among registered nurses in Sweden.

Background: Pressure ulcers are an adverse event and a problem worldwide. Risk assessment is a cornerstone, and a first step in pressure ulcer prevention is to identify possible risk patients and/or pressure ulcers. There are many pressure ulcer risk assessment instruments; however, they are not updated and/or evidence-based. PURPOSE T has been psychometrically evaluated in the UK and in Sweden with good inter-rater and test-retest reliability, and convergent validity was reported as moderate.

Design: A descriptive study design with a qualitative approach.

Methods: A total of six focus group interviews with 29 registered nurses were conducted. They were recruited from May 2018 to November 2018 from a university hospital and two nursing homes in Sweden. Data analysis was performed as described by Krueger. The study adheres to the COREQ guidelines.

Results: Four categories were identified: "An efficient risk assessment instrument performed at the bedside," "Deeper understanding and awareness of risk factors," "Benefits compared to the Modified Norton Scale" and "Necessity of integration of PURPOSE T in the electronic health record and team collaboration."

Conclusion: The registered nurses acknowledged an overall positive perception of PURPOSE T´s clinical usability. Future research is needed to evaluate the feasibility of PURPOSE T.

Relevance To Clinical Practice: PURPOSE T has the potential to replace outdated pressure ulcers risk assessment instruments that are used today.
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http://dx.doi.org/10.1111/jocn.15901DOI Listing
June 2021

A multifaceted intervention for evidence-based pressure ulcer prevention: a 3 year follow-up.

JBI Evid Implement 2020 Dec;18(4):391-400

Department of Public Care and Caring Sciences Uppsala University, Uppsala, Sweden.

Aim: To assess sustainability of an intervention used to implement pressure ulcer prevention.

Background: The Promoting Action on Research Implementation in Health Service, framework was used to develop an intervention aimed to implement evidence-based pressure ulcer prevention in a hospital setting. A short-term follow-up showed that significantly more patients received pressure ulcer prevention. A qualitative process evaluation gave support that the intervention and the implementation process changed the understanding and approach to working with pressure ulcer prevention from treating to preventing.

Method: The study had a sequential mixed method approach, combining quantitative and qualitative data. For the quantitative data, baseline and short-term follow-up (6-8 months) data reported in an initial study were compared with long-term follow-up (36-42 months) data (n = 259 patients). For the qualitative data, interviews with registered nurses (n = 20), assistant nurses (n = 7) and first-line managers (n = 5) were performed.

Results: The performance of pressure ulcer prevention was sustained 3 years from its conception. The number of patients with pressure ulcers was reduced (P = 0.021). Systematic work with quality measurements, support from first-line managers, internal facilitation, collaboration and pressure ulcer prevention skills could explained the sustainability. Obstacles to achieve high-quality pressure ulcer prevention were inadequate communication, high workloads and high rates of new and substitute nurses.

Conclusion: Three different components for sustainability on the micro-level are described; benefits for the patients, the need for routinization and development over time. Threats to sustainability are described as factors on the macro-level. There needs to be collaboration in the healthcare organization from the micro-to-macro levels, and committed experienced nurses are needed to obtain high-quality sustainable pressure ulcer prevention.
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http://dx.doi.org/10.1097/XEB.0000000000000239DOI Listing
December 2020

PURPOSE T in Swedish hospital wards and nursing homes: A psychometric evaluation of a new pressure ulcer risk assessment instrument.

J Clin Nurs 2020 Nov 19;29(21-22):4066-4075. Epub 2020 Aug 19.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Aim: To evaluate the psychometric characteristics of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T); reliability (inter-rater and test-retest) and validity (convergent validity) in a Swedish context.

Background: Pressure ulcers are considered as an adverse event and are a problem in healthcare worldwide. The first step in pressure ulcer prevention is to identify patients that are at risk. PURPOSE T is a new pressure ulcer risk assessment instrument that was developed in the UK using "golden standard" instrument method.

Design: Observational, descriptive and comparative.

Methods: A total of 235 patients and 28 registered nurses were recruited (May 2018-November 2018) from six hospital wards at a university hospital and two community nursing homes in Sweden. Blinded (ward/nursing home nurses and expert nurses) PURPOSE T assessments and follow-up retests were undertaken. Cross-tabulation and kappa statistics were used to examine the reliability, and phi correlation was used to test the convergent validity. The study followed the STROBE guideline.

Results: The clinical evaluation showed "very good" (kappa) inter-rater and test-retest reliability for PURPOSE T assessment decision overall. The agreement of "at risk"/"not at risk" for both inter-rater and test-retest was also high, at least 95.5%. The convergent validity between PURPOSE T and other traditional assessment instruments was moderate.

Conclusion: The evaluation of PURPOSE T demonstrated good psychometric characteristics. Further research is needed to evaluate PURPOSE T's usability among registered nurses.

Relevance To Clinical Practice: There is a lack of evidence-based validated pressure ulcer risk assessment instruments for use in health care. According to our findings, the Swedish version of PURPOSE T could be used in hospitals and nursing homes to identify patients in risk or with pressure ulcers.
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http://dx.doi.org/10.1111/jocn.15433DOI Listing
November 2020

A multifaceted intervention for evidence-based pressure ulcer prevention: a 3 year follow-up.

Int J Evid Based Healthc 2020 Jul 9. Epub 2020 Jul 9.

1Department of Patient Safety, Region Gävleborg, Gävle, Sweden 2Department of Public Care and Caring Sciences Uppsala University, Uppsala, Sweden 3Centre for Research and Development, Region Gävleborg/Uppsala University, Sweden 4Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle 5Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.

Aim: To assess sustainability of an intervention used to implement pressure ulcer prevention.

Background: The Promoting Action on Research Implementation in Health Service, framework was used to develop an intervention aimed to implement evidence-based pressure ulcer prevention in a hospital setting. A short-term follow-up showed that significantly more patients received pressure ulcer prevention. A qualitative process evaluation gave support that the intervention and the implementation process changed the understanding and approach to working with pressure ulcer prevention from treating to preventing.

Method: The study had a sequential mixed method approach, combining quantitative and qualitative data. For the quantitative data, baseline and short-term follow-up (6-8 months) data reported in an initial study were compared with long-term follow-up (36-42 months) data (n = 259 patients). For the qualitative data, interviews with registered nurses (n = 20), assistant nurses (n = 7) and first-line managers (n = 5) were performed.

Results: The performance of pressure ulcer prevention was sustained 3 years from its conception. The number of patients with pressure ulcers was reduced (P = 0.021). Systematic work with quality measurements, support from first-line managers, internal facilitation, collaboration and pressure ulcer prevention skills could explained the sustainability. Obstacles to achieve high-quality pressure ulcer prevention were inadequate communication, high workloads and high rates of new and substitute nurses.

Conclusion: Three different components for sustainability on the micro-level are described; benefits for the patients, the need for routinization and development over time. Threats to sustainability are described as factors on the macro-level. There needs to be collaboration in the healthcare organization from the micro-to-macro levels, and committed experienced nurses are needed to obtain high-quality sustainable pressure ulcer prevention.
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http://dx.doi.org/10.1097/XEB.0000000000000239DOI Listing
July 2020

Information and Communication Technology Can Increase Patient Participation in Pressure Injury Prevention: A Qualitative Study in Older Orthopedic Patients.

J Wound Ostomy Continence Nurs 2019 Sep/Oct;46(5):383-389

Lisa Hultin, MSc, Department of Public Health and Caring Sciences, Uppsala University; and Uppsala University Hospital, Uppsala, Sweden. Ann-Christin Karlsson, PhD, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; and Region Gotland, Visby, Sweden. Margareta Öhrvall, PhD, Department of Public Health and Caring Sciences, Uppsala University; and Uppsala University Hospital, Uppsala, Sweden. Lena Gunningberg, PhD, Department of Public Health and Caring Sciences, Uppsala University; and Uppsala University Hospital, Uppsala, Sweden.

Purpose: The aim of this study was to assess the participatory capabilities of hospitalized older adults in response to the Continuous Bedside Pressure Mapping system placed on the beds to prevent pressure injuries.

Design: Descriptive study.

Subjects And Setting: A convenience sample of 31 orthopedic patients were recruited from an orthopedic rehabilitation unit at a university hospital in Uppsala, Sweden, that served patients aged 65 years and older.

Methods: Semistructured interviews were conducted between November 2016 and February 2017, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis.

Result: The overall theme from 21 interviews was "A new way of understanding helped patients to recognize vulnerable pressure points and to take action in their own care" from which 2 categories, "awareness" and "action," emerged. The study showed that verbally adapted information combined with using information and communication technology increased most participants' knowledge and as they became aware of increased pressure, they started to take preventative action by changing position.

Conclusions: It is possible for older participants in a rehabilitation unit who had recent orthopedic surgery to understand and use new information and communication technology and should be invited to participate in pressure injury prevention.
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http://dx.doi.org/10.1097/WON.0000000000000568DOI Listing
March 2020

Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword.

J Nurs Manag 2019 Oct 31;27(7):1359-1365. Epub 2019 Jul 31.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Aim: To describe job satisfaction in registered nurses (RNs), their intention to stay at their current workplace and in the profession and to explore patient safety in relation to these.

Background: Nurse turnover presents a serious challenge to health care that may be predicted by factors related to the work environment.

Method: Descriptive design with 25 qualitative interviews.

Results: Five categories were identified: RNs feel satisfied when providing person-centred care; RNs enjoy the variability of the nursing job, but want control; RNs feel frustrated when care is put on hold or left undone; RNs depend on team collaboration and the work environment to assure patient safety; intention to stay depends on the work environment and a chance for renewal.

Conclusion: Registered nurses' job satisfaction could be described as a double-edged sword. Although the profession is described as a positive challenge, work overload threatens both job satisfaction and patient safety.

Implications For Nursing Management: Our findings suggest that nursing leadership can increase RNs' intention to stay by meeting their needs for appreciation, a better work environment, competence development and professional career development.
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http://dx.doi.org/10.1111/jonm.12816DOI Listing
October 2019

Evidence-based nursing-How is it understood by bedside nurses? A phenomenographic study in surgical settings.

J Nurs Manag 2019 Sep 17;27(6):1216-1223. Epub 2019 Jun 17.

Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Aim: The aim was to identify and describe nurses' understanding of working with evidence-based nursing (EBN) in clinical practice.

Background: Evidence-based health care is recognized as fundamental to nursing practice, but it is challenging to implement. How nurses understand this part of their work can affect their practice.

Methods: Using a qualitative explorative design with a phenomenographic approach, we interviewed 21 nurses working in Swedish surgical wards.

Results: We identified three understandings of EBN among nurses in surgical care: A. a fragmentary and difficult concept that is not integrated or used in clinical practice; B. an important approach guided by knowledgeable colleagues and students; and C. a process that nurses are responsible for developing and leading.

Conclusion: Nurses' understandings of working with EBN in surgical wards vary widely. Nurse managers have an important task to create a common outlook among nurses about integrating research, patient experience and clinical experience in decision-making.

Implication For Nursing Management: These findings could inspire nurse managers to reflect on how to move nurses towards a more comprehensive understanding of EBN and how to identify nurses who could act as facilitators in quality improvement work.
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http://dx.doi.org/10.1111/jonm.12802DOI Listing
September 2019

Tracking pressure injuries as adverse events: National use of the Global Trigger Tool over a 4-year period.

J Eval Clin Pract 2019 Feb 20;25(1):21-27. Epub 2018 Jul 20.

Department of Health Sciences, Karlstad University and County Council of Värmland, Sweden.

Aim: To examine the frequency, preventability, and consequences of hospital acquired pressure injuries in acute care hospitals over a 4-year period.

Method: A retrospective record review was performed using the Swedish version of the Global Trigger Tool (GTT). A total of 64 917 hospital admissions were reviewed. Data were collected between 2013 and 2016 from all 63 Swedish acute care hospitals.

Results: The prevalence of pressure injuries (category 2-4) was 1%. Older patients, "satellite patients", and patients with acute admissions had more pressure injuries. Most pressure injuries (91%) were determined to be preventable. The mean extended length of hospital stay was 15.8 days for patients who developed pressure injuries during hospitalization.

Conclusion: The GTT provides a useful and complementary national perspective on hospital acquired pressure injuries across hospitals, informing health care providers on safety priorities to reduce patient harm. Clinical leaders can use information on the preventability and the consequences of pressure injuries, as well as evidence-based arguments for improving the health care organization.
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http://dx.doi.org/10.1111/jep.12996DOI Listing
February 2019

Unavoidable pressure ulcers at the end of life and nurse understanding.

Br J Nurs 2017 Nov;26(Sup20):S6-S17

Clinical Professor, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.

Objectives: prevention of pressure ulcers (PUs) in end-of-life care is often problematic because both PUs and interventions to prevent them can cause suffering. The primary aim of this study was to identify and describe the different ways in which nurses understood unavoidable PUs in late palliative care. A second aim was to explore the expediency of the different levels of understanding.

Methods: a qualitative interview study with a phenomenographic approach was carried out. The study participants were nurses and healthcare assistants who worked in nursing homes or in specialist palliative inpatient care units run by private providers, non-profit foundations, municipalities and county councils. A phenomenographic analysis of the interview data was undertaken.

Results: all participants shared a fundamental understanding that the prevention of PUs is highly worthwhile in end-of-life care. Within this common view, practitioners' understanding of whether PUs could be prevented differed in four main ways, and were divided into categories: A: unavoidable PUs do not exist. All can be prevented if all interventions are applied, and all patients are at the same risk for developing PUs in end-of-life care; B: unavoidable PUs do not exist, but some patients do not participate in prevention interventions, which makes prevention difficult. The risk of developing pressure ulcers in end-of-life care varies between patients; C: some PUs are unavoidable because some patients do not participate in prevention interventions; the risk of developing pressure ulcers in end-of-life care differs between patients. D: some PUs are unavoidable, depending on the pathophysiological processes in the dying body. The risk of developing pressure ulcers in end-of-life care differs between patients.

Conclusion: it is paramount to communicate to nurses that not all PUs can be prevented in dying patients, to lessen the burden of ethical stress for the nurses.
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http://dx.doi.org/10.12968/bjon.2017.26.Sup20.S6DOI Listing
November 2017

Staff's perceptions of a pressure mapping system to prevent pressure injuries in a hospital ward: A qualitative study.

J Nurs Manag 2018 Mar 29;26(2):140-147. Epub 2017 Aug 29.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.

Aim: To describe staff's perceptions of a continuous pressure mapping system to prevent pressure injury in a hospital ward.

Background: Pressure injury development is still a problem in hospitals. It is important to understand how new information and communication technologies can facilitate pressure injury prevention.

Method: A descriptive design with qualitative focus group interviews was used.

Results: Five categories were identified: "Need of information, training and coaching over a long period of time," "Pressure mapping - a useful tool in the prevention of pressure injury in high risk patients," "Easy to understand and use, but some practical issues were annoying," "New way of working and thinking," and "Future possibilities with the pressure mapping system."

Conclusion: The pressure mapping system was an eye-opener for the importance of pressure injury prevention. Staff appreciated the real-time feedback on pressure points, which alerted them to the time for repositioning, facilitated repositioning and provided feedback on the repositioning performed.

Implications For Nursing Management: A continuous pressure mapping system can be used as a catalyst, increasing staff's competence, focus and awareness of prevention. For successful implementation, the nurse managers should have a shared agenda with the clinical nurse leaders, supporting the sustaining and spread of the innovation.
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http://dx.doi.org/10.1111/jonm.12526DOI Listing
March 2018

Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomised controlled trial.

Int J Nurs Stud 2017 Jul 21;72:53-59. Epub 2017 Apr 21.

Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden. Electronic address:

Background: Pressure ulcers cause suffering to patients and costs to society. Reducing pressure at the interface between the patient's body and the support surface is a valid clinical intervention for reducing the risk of pressure ulcers. However, studies have shown that knowledge of how to reduce pressure and shear and to prevent pressure ulcers is lacking.

Objective: To evaluate the effect of a pressure mapping system on pressure ulcer prevalence and incidence in a hospital setting.

Design: Pragmatic randomised controlled trial.

Setting: A geriatric/internal medical ward with 26 beds in a Swedish university hospital.

Participants: 190 patients were recruited (intervention: n=91; control: n=99) over a period of 9 months. Patients were eligible if they were over 50 years old, admitted to the ward between Sunday 4pm and Friday 4pm, and expected to stay in the ward ≥3 days.

Intervention: The continuous bedside pressure mapping system displays the patient's pressure points in real-time colour imagery showing how pressure is distributed at the body-mat interface. The system gives immediate feedback to staff about the patient's pressure points, facilitating preventive interventions related to repositioning. It was used from admittance to discharge from the ward (or 14 days at most). Both intervention and control groups received standard pressure ulcer prevention care.

Results: No significant difference in the prevalence and incidence of pressure ulcers was shown between intervention and control groups. The prevalence of pressure ulcers in the intervention group was 24.2% on day 1 and 28.2% on day 14. In the control group the corresponding numbers were 18.2% and 23.8%. Seven of 69 patients (10.1%) in the intervention group and seven of 81 patients (8.6%) in the control group who had no pressure ulcers on admission developed category 1 and category 2 ulcers during their hospital stay. The incidence rate ratio between the intervention and control groups was 1.13 (95% CI: 0.34-3.79).

Conclusions: This study failed to demonstrate a beneficial effect of a pressure mapping system on pressure ulcer prevalence and incidence. However, the study could have increased staff awareness and focus on pressure ulcer prevention, thus affecting the prevalence and incidence of pressure ulcers in a positive way in both study groups. It is important to further investigate the experience of the multidisciplinary team and the patients regarding their use of the pressure mapping system, as well as strengths and weaknesses of the system.
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http://dx.doi.org/10.1016/j.ijnurstu.2017.04.007DOI Listing
July 2017

Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff.

J Wound Ostomy Continence Nurs 2017 Mar/Apr;44(2):142-147

Lisa Hultin, MNS, Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden. Estrid Olsson, MNS, Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden. Cheryl Carli, PhD, Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden; and University Hospital, Uppsala, Sweden. Lena Gunningberg, PhD, Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.

Purpose: The purpose of this study was to evaluate the use of a pressure mapping system with real-time feedback of pressure points in elderly care, with specific focus on pressure injury (PI) knowledge/attitudes (staff), interface pressure, and PI prevention activities (residents).

Design: Descriptive, 1-group pretest/posttest study.

Subjects And Setting: A convenience sample of 40 assistant nurses and aides participated in the study; staff members were recruited at daytime, and 1 nighttime meeting was held at the facility. A convenience sample of 12 residents with risk for PI were recruited, 4 from each ward. Inclusion criteria were participants older than 65 years, Modified Norton Scale score 20 or less, and in need of help with turning in order to prevent PI. The study setting was a care facility for the elderly in Uppsala, Sweden.

Methods: A descriptive, comparative pretest/posttest study design was used. The intervention consisted of the use of a pressure mapping system, combined with theoretical and practical teaching. Theoretical and practical information related to PI prevention and the pressure mapping system was presented to the staff. The staff (n = 40) completed the Pressure Ulcer Knowledge and Assessment Tool (PUKAT) and Attitudes towards Pressure Ulcer (APuP) before and following study intervention. Residents' beds were equipped with a pressure mapping system during 7 consecutive days. Peak pressures and preventive interventions were registered 3 times a day by trained study nurses, assistant nurses, and aides.

Results: Staff members' PUKAT scores increased significantly (P = .002), while their attitude scores, which were high pretest, remained unchanged. Peak interface pressures were significantly reduced (P = .016), and more preventive interventions (n = 0.012) were implemented when the staff repositioned residents after feedback from the pressure mapping system.

Conclusions: A limited educational intervention, combined with the use of a pressure mapping system, was successful as it improved staff members' knowledge about PI prevention, reduced interface pressure, and increased PI prevention activities. As many of the staff members lacked formal education in PI prevention and management, opportunities for teaching sessions and reflection upon PI prevention should be incorporated into the workplace. More research is needed to evaluate the effect of continuous pressure mapping on the incidence of PI.
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http://dx.doi.org/10.1097/WON.0000000000000301DOI Listing
September 2017

Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project.

J Nurs Manag 2017 May 6;25(4):266-275. Epub 2017 Feb 6.

Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden.

Aim: To evaluate an implementation project on patient participation.

Background: Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years.

Method: Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed.

Results: Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients' involvement in their own care. Several barriers to change and sustainability were acknowledged.

Conclusions: Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement.

Implications For Nursing Management: A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care.
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http://dx.doi.org/10.1111/jonm.12459DOI Listing
May 2017

Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip fracture patients receiving urine catheter: a double-blind randomized trial.

Clin Interv Aging 2017 13;12:137-143. Epub 2017 Jan 13.

Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Background: Urinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters.

Aim: The aim of this study is to investigate whether intake of cranberry juice concentrate pre-operatively decreases the incidence of postoperative UTIs in hip fracture patients that received a urinary catheter.

Design: This study employed a randomized, placebo-controlled double-blind trial.

Method: Female patients, aged 60 years and older, with hip fracture (n=227) were randomized to receive cranberry or placebo capsules daily, from admission, until 5 days postoperatively. Urine cultures were obtained at admission, 5 and 14 days postoperatively. In addition, Euro Qual five Dimensions assessments were performed and patients were screened for UTI symptoms.

Result: In the intention-to-treat analysis, there was no difference between the groups in the proportion of patients with hospital-acquired postoperative positive urine cultures at any time point. When limiting the analysis to patients that ingested at least 80% of the prescribed capsules, 13 of 33 (39%) in the placebo group and 13 of 47 (28%) in the cranberry group (=0.270) had a positive urine culture at 5 days postoperatively. However, this difference was not statistically significant (=0.270).

Conclusion: Cranberry concentrate does not seem to effectively prevent UTIs in female patients with hip fracture and indwelling urinary catheter.
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http://dx.doi.org/10.2147/CIA.S113597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245868PMC
January 2018

Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting.

J Clin Nurs 2017 Oct 21;26(19-20):3200-3211. Epub 2017 Mar 21.

Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.

Aims And Objectives: To describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multifaceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention.

Background: Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes.

Design: A descriptive qualitative approach.

Method: Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used.

Result: The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements.

Conclusion: The multifaceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feedback discussions among the staff regarding the results of the care provided also appear to be vital.

Relevance To Clinical Practice: It is crucial that dedicated facilitators are involved to promote the implementation process. A preventative mindset should be strived for. Creating an implementation plan with an outcome and a process evaluation should be emphasised. It is important to give the staff regular feedback on the quality of care and on those occasions allocate time for discussion and reflection.
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http://dx.doi.org/10.1111/jocn.13668DOI Listing
October 2017

Heel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study.

Scand J Trauma Resusc Emerg Med 2016 Nov 14;24(1):134. Epub 2016 Nov 14.

Faculty of Health, Sciences and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.

Background: Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain.

Methods: Existing data collected from a multi-centre randomized controlled trial investigating the effect of using a heel prevention boot to reduce the incidence of heel pressure ulcer across the care delivery chain was used. Totally 183 patients participated. The settings for the study were five ambulance stations, two emergency departments and 16 wards at two hospitals in Sweden.

Results: A total of 39 individual patients (21 %) developed heel pressure ulcer at different stages across the care delivery chain. Findings revealed that 47-64 % of the patients were assessed as being at risk for developing heel pressure ulcer. Preventive action was taken. However, all patients who developed pressure ulcer during the care delivery chain did not receive adequate pressure ulcer prevention actions during their hospital stay.

Discussion And Conclusions: In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.

Trial Registration: ISRCTN85296908 .
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http://dx.doi.org/10.1186/s13049-016-0326-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109774PMC
November 2016

Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study.

J Palliat Med 2017 01 22;20(1):53-58. Epub 2016 Sep 22.

Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden .

Background: The scientific knowledge about pressure ulcers (PUs) is growing, but there is a shortage of studies of PUs at end of life. The recommendations regarding PU prevention in palliative care (PC) are based on consensus documents.

Aim: To use data from a national register to identify predictors for development of PUs at the end of life.

Design: A retrospective, descriptive, and comparative study design was used.

Setting/participants: All deceased patients over 17 years old (n = 60,319) and registered in the Swedish Register of Palliative Care (SRPC) during 2014 were included.

Statistical Analysis: Logistic regression.

Results: In the full model, all health units except general palliative home care had a significantly higher incidence of PUs than did the nursing homes. The well-known predictors of PUs in general, diabetes, postfracture state, infections, and multiple sicknesses, are predictors even in dying patients. Dementia was significantly associated with lower likelihood of PUs, while pain was associated with more PUs. Intravenous drip or enteral feeding was associated with a significantly decreased likelihood of developing PUs.

Conclusions: The SRPC could be a unique resource for quality improvement and research. The present study cannot prove causation, but it can report correlations between background variables and PU prevalence. More studies, with different designs, are warranted to establish the roles of risk factors for PU in end-of-life care.
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http://dx.doi.org/10.1089/jpm.2016.0166DOI Listing
January 2017

Successful factors to prevent pressure ulcers - an interview study.

J Clin Nurs 2017 Jan;26(1-2):182-189

Department of Health Sciences, Karlstad University, Karlstad, Sweden.

Aims And Objectives: To explore successful factors to prevent pressure ulcers in hospital settings.

Background: Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2·7-36·4%.

Design: Qualitative semistructured interviews were conducted.

Methods: A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014.

Results: Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients.

Conclusion: The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work.

Relevance To Clinical Practice: The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention.
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http://dx.doi.org/10.1111/jocn.13465DOI Listing
January 2017

Effect of e-learning program on risk assessment and pressure ulcer classification - A randomized study.

Nurse Educ Today 2016 May 18;40:191-7. Epub 2016 Mar 18.

Institute of Health and Society, University of Oslo, Norway. Electronic address:

Background: Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian.

Objectives: Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification.

Methods:

Design, Participants And Setting: Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012.

Analysis: Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables.

Results: An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups.

Conclusion: An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected.
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http://dx.doi.org/10.1016/j.nedt.2016.03.008DOI Listing
May 2016

Patients' knowledge of and participation in preventing pressure ulcers- an intervention study.

Int Wound J 2017 Apr 26;14(2):344-348. Epub 2016 Apr 26.

Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden.

The aim of this study was to evaluate a patient information pamphlet on pressure ulcer (PU) prevention using a descriptive, comparative pre- and post-test study design. The patient information pamphlet 'How can you help to stop pressure ulcers?' developed by the European PU Advisory Panel in 2012 was implemented in two surgical wards in a university hospital. A total of 61 patients answered pre- and post-test questionnaires. Patients assessed their knowledge of the risks, causes and ways to prevent PUs significantly higher after the intervention than before. Twenty-eight patients (46%) reported that they had participated in PU prevention during the last 24 hours. The patients assessed the content of the PU pamphlet as useful, its language as quite easy to understand and its layout as good. Patients with a PU pamphlet during their hospital stay were more knowledgeable about and more active in their own care. It is important that nurses invite patients to be active partners in preventing PUs but also that they identify patients who need to have a more passive role. The PU pamphlet could be updated to increase its comprehensibility, meaningfulness and manageability for patients.
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http://dx.doi.org/10.1111/iwj.12606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950178PMC
April 2017

Prevention of heel pressure ulcers among older patients--from ambulance care to hospital discharge: A multi-centre randomized controlled trial.

Appl Nurs Res 2016 May 26;30:170-5. Epub 2015 Oct 26.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; School of Nursing, University of Adelaide, Adelaide, Australia; Department of Emergency Care, Uppsala University Hospital, Uppsala, Sweden.

Unlabelled: The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+).

Background: Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used.

Methods: A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards.

Results: Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017).

Conclusions: Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety.
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http://dx.doi.org/10.1016/j.apnr.2015.10.003DOI Listing
May 2016

Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis.

BMJ Open 2015 Aug 27;5(8):e007584. Epub 2015 Aug 27.

Institute of Health and Society, University of Oslo, Oslo, Norway.

Objectives: To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors.

Design: Multilevel approach to data from 2 cross-sectional studies.

Settings: 4 hospitals in Norway were studied.

Participants: 1056 patients at 84 somatic wards.

Primary Outcome Measure: HAPU.

Results: Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25-29.99 kg/m(2)) (OR 0.32 (95% CI 0.17 to 0.62)).

Conclusions: The fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.
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http://dx.doi.org/10.1136/bmjopen-2015-007584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554903PMC
August 2015

To Receive or Not to Receive Analgesics in the Emergency Department: The Importance of the Pain Intensity Assessment and Initial Nursing Assessment.

Pain Manag Nurs 2015 Oct 29;16(5):743-50. Epub 2015 May 29.

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Uppsala University Hospital, Surgery and Oncology Division, Uppsala, Sweden.

Patients seeking emergency care for abdominal pain still experience poor pain management. Pain intensity is not always seen as a mandatory parameter in the initial nurse assessment. Despite the development of nurse-initiated analgesic protocols, many patients do not receive analgesics in the emergency department. The aim of this study was to describe initial nursing assessment related to pain management and to identify predictors for receiving or not receiving analgesics in the emergency department. The sample consists of 100 patients from an intervention group in a previously undertaken Swedish intervention study. The main findings were that the registered nurses assessed 62 patients as being in need of analgesics, and that 52 of these obtained analgesics. The majority of the patients assessed as not being in need of analgesics did not receive analgesics because they did not want medication. Median value for pain intensity at initial assessment was 6 on the numerical rating scale. The results for the logistic regression (n = 80) showed significant differences between receiving analgesics/not receiving analgesics and the predictor pain intensity (measured at initial nurse assessment). Nurses in emergency departments play a crucial role, in that their initial assessment is of specific importance for the patient's further care and whether the patient may or may not receive analgesics. However, more attention has to be paid to patients' experiences and their expectations regarding the pain management in the emergency department. These complex questions have to be studied further in a more systematic way.
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http://dx.doi.org/10.1016/j.pmn.2015.04.004DOI Listing
October 2015

Postsurgical Acute Phase Reaction is Associated with Decreased Levels of Circulating Myostatin.

Inflammation 2015 Aug;38(4):1727-30

Department of Medical Sciences, Uppsala University, Uppsala, Sweden,

Muscle strength is of importance for postsurgical rehabilitation. Myostatin is a growth factor that regulates the size of muscles and could thus influence muscle mass and function in the postsurgical period. The aim of the present study was to study the changes in myostatin levels during the postsurgical inflammatory period. Myostatin was analysed in serum samples from two elective surgery groups, orthopaedic surgery (n = 24) and coronary bypass patients (n = 21). The samples were collected prior to surgery and 4 and 30 days after surgery. In the orthopaedic group, the median myostatin levels decreased from 3582 ng/L prior to surgery to 774 ng/L at day 4 (p < 0.001) and to 2016 ng/L at day 30 (p < 0.001). Median CRP increased from 2.35 mg/L preoperatively to 117 mg/L at day 4 and decreased to 5.5 mg/L at day 30 in the same group. The coronary bypass group showed a similar pattern with a decrease in myostatin from 4212 ng/L to 2574 ng/L at day 4 (p < 0.001) and to 2808 ng/L at day 30 (p = 0.002). Median CRP increased from 1.80 mg/L preoperatively to 136 mg/L at day 4 and returned to 6.12 mg/L at day 30 in the coronary bypass group. There was a significant decrease in myostatin concentrations both in the early and late postsurgical period. The lowest myostatin concentration time point coincided with the highest CRP concentration time point.
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http://dx.doi.org/10.1007/s10753-015-0149-6DOI Listing
August 2015

The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study.

Int J Nurs Stud 2015 Jan 18;52(1):149-56. Epub 2014 Jul 18.

Institute of Health and Society, University of Oslo, Norway.

Background: Pressure ulcers are preventable adverse events. Organizational differences may influence the quality of prevention across wards and hospitals.

Objective: To investigate the prevalence of pressure ulcers, patient-related risk factors, the use of preventive measures and how much of the pressure ulcer variance is at patient, ward and hospital level.

Design: A cross-sectional study.

Setting: Six of the 11 invited hospitals in South-Eastern Norway agreed to participate.

Participants: Inpatients ≥18 years at 88 somatic hospital wards (N=1209). Patients in paediatric and maternity wards and day surgery patients were excluded.

Methods: The methodology for pressure ulcer prevalence studies developed by the European Pressure Ulcer Advisory Panel was used, including demographic data, the Braden scale, skin assessment, the location and severity of pressure ulcers and preventive measures. Multilevel analysis was used to investigate variance across hierarchical levels.

Results: The prevalence was 18.2% for pressure ulcer category I-IV, 7.2% when category I was excluded. Among patients at risk of pressure ulcers, 44.3% had pressure redistributing support surfaces in bed and only 22.3% received planned repositioning in bed. Multilevel analysis showed that although the dominant part of the variance in the occurrence of pressure ulcers was at patient level there was also a significant amount of variance at ward level. There was, however, no significant variance at hospital level.

Conclusions: Pressure ulcer prevalence in this Norwegian sample is similar to comparable European studies. At-risk patients were less likely to receive preventive measures than patients in earlier studies. There was significant variance in the occurrence of pressure ulcers at ward level but not at hospital level, indicating that although interventions for improvement are basically patient related, improvement of procedures and organization at ward level may also be important.
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http://dx.doi.org/10.1016/j.ijnurstu.2014.07.005DOI Listing
January 2015

Elective orthopedic and cardiopulmonary bypass surgery causes a reduction in serum endostatin levels.

Eur J Med Res 2014 Nov 8;19:61. Epub 2014 Nov 8.

Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden.

Background: Endostatin is an endogenous inhibitor of angiogenesis that inhibits neovascularisation. The aim of the study was to evaluate the effect of elective surgery on endostatin levels.

Methods: Blood samples were collected prior to elective surgery and 4 and 30 days postoperatively in 2 patient groups: orthopedic surgery (n =27) and coronary bypass patients (n =21). Serum endostatin levels were measured by ELISA.

Results: Serum endostatin was significantly reduced 30 days after surgery in comparison with presurgical values in both the orthopedic (P =0.03) and cardiopulmonary surgery (P =0.04) group.

Conclusion: Serum endostatin is reduced 30 days after surgery. This reduction would favor angiogenesis and wound-healing.
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http://dx.doi.org/10.1186/s40001-014-0061-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230358PMC
November 2014

Reduced pressure for fewer pressure ulcers: can real-time feedback of interface pressure optimise repositioning in bed?

Int Wound J 2016 Oct 16;13(5):774-9. Epub 2014 Sep 16.

Department of Haematology, Uppsala University Hospital, Uppsala, Sweden.

The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.
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http://dx.doi.org/10.1111/iwj.12374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950071PMC
October 2016

Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument.

Int Wound J 2016 Oct 14;13(5):655-62. Epub 2014 Aug 14.

Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.

The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.
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http://dx.doi.org/10.1111/iwj.12338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950033PMC
October 2016

Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting.

Int Wound J 2016 Oct 25;13(5):645-54. Epub 2014 Jul 25.

Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Gävle, Sweden.

The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.
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http://dx.doi.org/10.1111/iwj.12337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950133PMC
October 2016

Medication administration accuracy: using clinical observation and review of patient records to assess safety and guide performance improvement.

J Eval Clin Pract 2014 Aug 5;20(4):411-6. Epub 2014 May 5.

Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.

Rationale, Aims And Objectives: Medication-related errors are common and can occur at every step of the medication process. The aim was to explore (1) the extent to which nurses perform fundamental safe practices related to medication administration (MA); (2) the frequency and characteristics of MA errors; and (3) the clinical significance of medication types (classes) subject to error.

Methods: A descriptive, exploratory cross sectional design with point in time sampling was used combining direct observations, conducted by naïve observers, and medical record review. A convenience sample of three adult surgical units was drawn from a 1000-bed university hospital. Seventy-two patient-nurse MA encounters were observed including 306 MA doses based on a minimum sample of 100 doses per unit. The Medication Administration Accuracy Assessment developed by the Collaborative Alliance for Nursing Outcomes in the United States was used.

Results: Observed adherence to MA safe practices varied between units. Identity control (9%), explaining medication to patient (11%) and medication labelled throughout the process (25%) were found to be safe practices with greatest deviation. 18% of doses involved a MA error (n = 54). Wrong time (9%) was the most common MA error, typically involving analgesics.

Conclusions: Given recent reports suggesting MA safe practices are strongly associated with MA errors, it is timely to strengthen RN awareness of the critical role of safe practices in MA safety. In nursing education, clinical examination using the six safe practices studied herein may enhance medication administration accuracy.
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http://dx.doi.org/10.1111/jep.12150DOI Listing
August 2014
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