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To analyse existing knowledge on the psychometric properties of the Braden Scale when used within the acute care setting.
Systematic review and narrative synthesis.
A database search was conducted in June 2023 and updated in February 2024, seeking studies testing the psychometric properties of the Braden scale in the acute care setting. Data were sourced from five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science). Study selection, data extraction and assessment of risk of bias were completed, with two reviewers independently conducting each stage and an independent reviewer arbitrating discrepancies. Data were extracted using a customised template and synthesised narratively. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.
Thirty-seven studies met the inclusion criteria. Internal consistency was reported between 0.64 and 0.78 (Cronbach's alpha). Inter-rater reliability was high, reported as ranging from 0.946 to 0.964 (intra-class correlations) or 0.86 to 0.949 (Pearson's correlation). Most validity studies tested predictive validity with wide variances reported.
The Braden Scale is reliable for assessing the risk of PI in acute care, but the validity of the scale is variable. Further research investigating validity beyond predictive validity is required.
Nurses working in acute care can use the Braden Scale with confidence of scale reliability. However, validity is variable and warrants a cautious approach. The true value resides in the capacity to trigger recognition of pressure injury risk.
Trial Registration: The protocol was registered a priori with the International Prospective Register of Systematic Reviews PROSPERO ref: CRD42023407545
To describe the cumulative incidence and characteristics of hospital-acquired pressure injury in acute palliative patients.
Secondary data analysis of hospital-acquired pressure injuries during 2019–2022.
The setting was a palliative care unit at a tertiary hospital in Queensland, Australia, including adult (≥ 18 years) acute-phase palliative inpatients. Retrospective data from four databases were used to identify and analyse hospital-acquired pressure injury cases from 2019 to 2022. Clinical characteristics of patients with and without hospital-acquired pressure injury were compared.
The incidence of hospital-acquired pressure injury in acute palliative care patients was 3.9% over the 4 years. These patients were predominantly male, with an average age of 74 years, with 66 of 78 cases developing in the deteriorating palliative care phase. Using the Waterlow Score, 51.3% of patients were assessed as at very high risk of pressure injury. Ninety-five hospital-acquired pressure injuries were reported in 78 patients; 16.8% were medical device-related, 40% were Stage 1 injuries, and the most common injury sites were the sacrum, heels and genitals. Patients with hospital-acquired pressure injury had significantly higher (worse) scores on both the palliative care Resource Utilisation Group-Activities of Daily Living and Problem Severity Scores. Regression analysis identified a high Problem Severity Score on admission as a significant predictor for hospital-acquired pressure injury development.
The incidence of hospital-acquired pressure injury in acute palliative patients is lower than in previous studies. However, many injuries occurred in those in the deteriorating phase, with higher scores for severity of symptoms. These findings suggest that acute palliative patients do require nursing care for pressure injury prevention, as well as for symptom management and activities-of-daily-living. Overall, this research contributes to a deeper understanding of pressure injury incidence and characteristics for acute palliative care patients. Future research should focus on population-specific pressure injury risk assessment to explore risk factors in greater detail.
Current pressure injury risk assessment tools, like the Waterlow Score, may not provide the comprehensive evaluation needed for the acute palliative care cohort. To better address the unique needs of this cohort, it may be necessary to refine existing tools or develop new instruments that integrate palliative-specific assessments, such as the Resource Utilisation Group-Activities-of-Daily-Living (RUG-ADL) and Problem (symptom) Severity Score (PSS). These adaptations could help improve pressure injury prevention care planning and enhance outcomes for patients in this setting.
This study separated acute palliative care patients from those at end-of-life and found a 3.9% cumulative incidence of pressure injuries. There were no significant differences in age, gender, or cancer diagnosis between patients with and without injuries. Patients without injuries were more likely to be in the deteriorating phase, while those with injuries had higher (worse) RUG-ADL scores. Regression analysis showed that each one-point increase in the PSS (symptom severity) made patients 1.2 times more likely to develop a pressure injury. The findings suggest that combining a validated risk assessment tool with the RUG-ADL and PSS tools could provide a more accurate risk assessment for hospitalised acute palliative care patients.
STROBE reporting guideline.
No patient or public contribution.
To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings.
A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach.
Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared.
English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.
Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients.
The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research.
A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings.
This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews.
This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions.
Trial Registration: The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885
To explore intensive care nurses' (ICN) perceptions of simulation-based learning (SBL).
A systematic review and meta-synthesis.
The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark's thematic analysis approach. Quality appraisal was assessed using the CASP tool.
Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration.
The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN's education.
These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting.
This review involved analysis of existing literature and as such no unique patient or public involvement occurred.
The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.
FreshRSS 