The Wound care competence of graduating student nurses – development and testing of a competence assessment instrument

Wound care is an essential element of clinical nursing and it requires versatile competence from nursing professionals. Patients with wounds are cared for almost everywhere in the health care system from emergency departments to care for the elderly, but chronic wounds, in particular, are a significant concern for today’s health care systems due to an ageing population. The competence of graduating student nurses has become an essential issue in relation to professional standards and patient safety. The aim of this study was i) to explore graduating student nurses’ wound care competence, ii) to identify the requested competence areas for registered nurses providing wound care and iii) to develop and test a new wound care competence assessment instrument that could be used to assess the objective wound care competence of graduating student nurses. This study was conducted in two phases: 1) theoretical and descriptive phase, 2) instrumentation and evaluation phase. Phase 1 comprised a literature review and a cross-sectional study (n=213 students) describing the topic using previous literature and empirical data. Phase 2 consisted of a qualitative study using focus-group interviews (n=23 health care professionals) and an instrument development study (n=135 students and professionals). The data were collected between 2016 and 2019 from various Finnish universities of applied sciences and health care organizations. The data were analysed using both qualitative and statistical analysis. The results indicated that the wound care competence of graduating student nurses was insufficient, but the students showed a positive attitude towards wound care. Three main competence areas regarding registered nurses’ wound care knowledge, skills and performance were identified, as well as six competence areas regarding the values and attitudes relating to wound care. The developed wound care competence instrument included a knowledge test, simulation and an attitude assessment; it demonstrated preliminary validity, reliability and sensitivity, but further testing is needed. The results of this study warrant closer examination and development of wound care education to ensure that future health care professionals have sufficient competence to perform evidence-based, best quality wound care.Valmistuvien sairaanhoitajaopiskelijoiden haavanhoidon osaaminen – arviointimittarin kehittäminen ja testaus Haavanhoito on keskeinen osa kliinistä hoitotyötä, ja se vaatii monipuolista osaamista hoitotyön ammattilaisilta. Haavaa sairastavia potilaita hoidetaan lähes kaikkialla terveydenhuollossa, päivystysyksiköistä vanhustenhoitoon, mutta erityisesti krooniset haavat ovat merkittävä haaste tämän päivän terveydenhuollolle johtuen ikääntyvästä väestörakenteesta. Valmistuvien sairaanhoitajaopiskelijoiden osaamisen tarkastelu on tärkeää ammatillisen tason ja potilasturvallisuuden kannalta. Tutkimuksen tarkoituksena oli i) tarkastella valmistuvien sairaanhoitajaopiskelijoiden haavanhoidon osaamista, ii) tunnistaa sairaanhoitajien haavanhoidon osaamisalueet ja iii) kehittää ja testata uusi haavanhoidon osaamismittari valmistuvien sairaanhoitajaopiskelijoiden haavanhoidon osaamisen arviointiin. Tutkimus toteutettiin kahdessa vaiheessa: 1) teoreettinen ja kuvaileva vaihe, 2) instrumentointi- ja arviointivaihe. Vaihe 1 käsitti kirjallisuuskatsauksen sekä poikkileikkaustutkimuksen (n=213 opiskelijaa), missä kuvattiin aihetta aikaisemman kirjallisuuden sekä empiirisen aineiston kautta. Vaihe 2 koostui laadullisesta tutkimuksesta, joka toteutettiin fokusryhmähaastatteluin (n=23 terveydenhuollon ammattilaista), sekä mittarin kehittämistutkimuksesta (n=135 opiskelijaa ja ammattilaista). Aineisto kerättiin vuosina 2016–2019 useista suomalaisista ammattikorkeakouluista sekä terveydenhuollon organisaatioista. Aineisto analysoitiin sekä laadullisesti että tilastollisesti. Tulokset osoittivat, että valmistuvien sairaanhoitajaopiskelijoiden haavanhoidon osaamisessa oli puutteita, mutta opiskelijoiden asenteet haavanhoitoa kohtaan olivat positiiviset. Kolme pääosaamisaluetta koskien sairaanhoitajien haavanhoidon tietoa, taitoa ja toimintaa tunnistettiin, sekä kuusi osaamisaluetta koskien haavanhoidon arvoja ja asenteita. Kehitetty osaamismittari sisälsi tietotestin, simulaation ja asenteiden arvioinnin, ja se osoitti alustavaa validiteettia, luotettavuutta ja sensitiivisyyttä, mutta jatkotestausta tarvitaan. Tulokset ohjaavat tarkastelemaan ja kehittämään haavanhoidon koulutusta, jotta tulevaisuuden terveydenhuollon ammattilaisilla olisi riittävä osaaminen näyttöön perustuvan ja laadukkaan haavanhoidon toteuttamiseen

Maturity of health care testbeds – A qualitative mapping at the Nordic context

This qualitative mapping aimed to report health care testbed activities in Finland and two other Nordic countries and describe the maturity of these testbeds. The data were collected in 2021 with semi-structured interviews from twelve organizations, of which seven were university hospitals, four universities of applied sciences and one primary health care organization. The data were analyzed using deductive content analysis based on previously identified maturity factors: resources, facilities, marketing and communications, repeatability, contract models, certification and standards compliance and time at the market area. According to the results, there were testbed activities in all participating organizations. The testbed activities mainly were funded from various projects, and the staff mainly consisted of single employees. The testbed facilities were both real-life environments and test or simulation labs. The marketing and communications were based on web pages, social media, events and networks. The repeatability was ensured primarily with usability testing, and the contract models were under development in most organizations. Certification and standards of compliance were rare. Time at the market area was relatively short in many organizations as the activities were mainly testing single products or services rather than continuous co-creation. Testbed activities in the health care and higher education organizations are merging with the daily operations in Nordic countries. Specialization within the organizations was seen, for example, robotics, rehabilitation or medical devices. Testbed organizations highlighted the need for more structured and coordinated processes and activities in order to ensure the management, quality and effectiveness of their testbed services

Learning goals and content for wound care education in Finnish nursing education-A Delphi study

Background: Caring for patients with wounds requires diverse competences from nursing professionals. However, wound care education in undergraduate nursing education is often fragmented and lacks consistent learning goals and content. Objectives: To create learning goals and content for wound care education in Bachelor's level nursing education in Finland and to assess the consensus relating to these learning goals and content among wound care experts. Design: A consensus-building approach using the Delphi technique. Settings: A Delphi panel of wound care experts built on an online platform. Participants: The participants of the Delphi panel were registered nurses, authorised wound care nurses, nurse educators and physicians. Methods: Learning goals and content for wound care education which had been formulated on the basis of previous focus-group interviews were presented to the Delphi panel. The data were collected in 2021 with two online Delphi rounds: 51 panellists participated in the first round and 36 in the second round. The data were analysed using statistical and qualitative analysis. Results: Learning goals and content were divided into four competence areas: 1) Anatomy and physiology, 2) Care of chronic and acute wounds, 3) Wound management and care of a patient with a wound, 4) Values and atti-tudes. These competence areas comprised 26 learning goals and 29 pieces of content. The consensus between the panellists was high, at >90% in all competence areas. Conclusions: The basis of registered nurses' wound care competence is built during their undergraduate nursing studies. The results of this study can be used to standardise wound care education by implementing consistent learning goals and content in Bachelor's level nursing education.</p

Maturity of health care testbeds – A qualitative mapping at the Nordic context

This qualitative mapping aimed to report health care testbed activities in Finland and two other Nordic countries and describe the maturity of these testbeds. The data were collected in 2021 with semi-structured interviews from twelve organizations, of which seven were university hospitals, four universities of applied sciences and one primary health care organization. The data were analyzed using deductive content analysis based on previously identified maturity factors: resources, facilities, marketing and communications, repeatability, contract models, certification and standards compliance and time at the market area. According to the results, there were testbed activities in all participating organizations. The testbed activities mainly were funded from various projects, and the staff mainly consisted of single employees. The testbed facilities were both real-life environments and test or simulation labs. The marketing and communications were based on web pages, social media, events and networks. The repeatability was ensured primarily with usability testing, and the contract models were under development in most organizations. Certification and standards of compliance were rare. Time at the market area was relatively short in many organizations as the activities were mainly testing single products or services rather than continuous co-creation. Testbed activities in the health care and higher education organizations are merging with the daily operations in Nordic countries. Specialization within the organizations was seen, for example, robotics, rehabilitation or medical devices. Testbed organizations highlighted the need for more structured and coordinated processes and activities in order to ensure the management, quality and effectiveness of their testbed services.</p

Areas of nursing competence in acute wound care: A focus group study

BackgroundWound care is an essential part of registered nurses’ work. However, previous studies have indicated that registered nurses have limited competence in this area. Studies have also highlighted the lack of consistent and standardised areas of competence for registered nurses providing wound care.AimTo identify general areas of competence for registered nurses providing acute wound care during their transition from student to healthcare professional.MethodsFocus group interviews were used to collect the data (N = 20). Separate focus groups were held for participants representing the following professions: (i) registered nurses; (ii) authorised wound care nurses; (iii) nurse educators; and (iv) physicians. The data were analysed using two-step inductive-deductive content analysis.FindingsThe two main competence areas for registered nurses who provide care for patients with acute wounds were: (i) knowledge, skills, and performance in aetiology and care; and (ii) wound management and assessment. These competence areas were divided into more detailed subcategories. The desired values and attitudes were as follows: respect for autonomy and privacy; holistic care; professionalism and courage; and economics related to wound care.DiscussionRegistered nurses play an essential role in the care and prevention of wounds. Nursing education on acute wound care could focus on the identified competence areas to cover the core competences for providing evidence-based, best-quality care for patients with acute wounds.ConclusionsWith consistent and structured competence areas, it would be possible to develop and improve wound care education and training at the undergraduate and postgraduate level.</p

Physical, social, and symbolic environment related to physical activity of older individuals in long-term care: A mixed-method systematic review

Background: Being active in old age is vital for health and well-being. Inactivity decreases functional ability, mo-bility, and increases care dependence and risk of falling. Worryingly, older individuals in long-term care settings spend most of their waking day sitting or lying down. The environment should be of special interest considering active life in long-term care. This review aimed to synthesize evidence and provide a comprehensive understand-ing of the environmental aspects related to the physical activity of older individuals in long-term care settings.Methods: A mixed-method systematic review, registered in PROSPERO (CRD42021251899; May 30th, 2021) was conducted using four international scientific databases (CINAHL, PubMed, Cochrane, PsychInfo). The searches were conducted from the earliest possible date till Dec 31st, 2020. All empirical peer-reviewed studies published in the English language in scientific journals were included if they had investigated environmental aspects (phys-ical, social, and/or symbolic) in relation to the physical activity of older individuals in long-term care facilities pro-viding full-time care. Critical appraisal was conducted using Joanna Briggs Institute's Critical Appraisal tools, and the Mixed Method Appraisal Tool. Abductive thematic analysis and a conceptual map were used to synthesize the evidence.Results: Altogether 838 original articles were assessed for eligibility, resulting in 30 included studies. No studies were excluded based on quality. The mean age of residents was over 75 when reported. Their cognitive and phys-ical functioning varied. The most frequent setting was nursing home. Three themes and corresponding descrip-tive themes were formulated, including 1) Physical environment: accessible and safe living environment, activating physical environment, 2) Social environment: supportive professionals, the role of other people, ade-quate activities to socialize and be active, and 3) Symbolic environment: policy at multiple levels, values of orga-nizations and professionals. Different environmental aspects within and between the dimensions of the physical, social, and symbolic environment were related to each other.Conclusions: A comprehensive synthesis of current evidence was provided and may be used for the assessment and development of long-term care settings. However, some aspects may have been missed because they have been addressed with terminology not identified with the word environment or similar concepts. As increasing activity may require actions in multiple dimensions, experimental research should be conducted to develop and test the effects of widescale modifications to existing environments from the needs of residents and fitting for each context. The evidence should be used for the design of new facilities. Tweetable abstract: Environmental aspects at multiple levels should be addressed to increase the activity of older long-term care residents.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).</p

Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross‐sectional study

The aim of this correlational, cross‐sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self‐reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence‐based pressure ulcer prevention practices should be promoted

Consistent practices in pressure ulcer prevention based on international care guidelines: A cross-sectional study

The use of consistent and evidence-based practices is essential in terms of patient safety and quality of care. The purpose of this study was to describe the use of consistent practices in PU prevention based on international care guidelines and to assess the validity and reliability of the pressure ulcer prevention practice (PUPreP) instrument. The data (n = 554) were collected between 2018 and 2019 from nursing professionals working at two hospital districts in Finland using the PUPreP instrument. The instrument consisted of 42 items assessing participants' perceptions of the frequencies of pressure ulcer prevention practices with the following scale: never, sometimes, often, always. The data were analysed using statistical analysis. According to the results, the use of pressure ulcer prevention practices was more frequently described as often. The most frequently used prevention practice was repositioning, and the least frequently used practice was nutrition. Factors related to nursing professionals' pressure ulcer prevention practices were the working sector, education and working frequency in pressure ulcer prevention, and early identification of pressure ulcers. The study results suggest that the evidence-based pressure ulcer prevention practices were followed at a moderate level by nurses. The PuPreP instrument demonstrated validity and reliability, but further development is needed

A systematic and psychometric review of tests measuring nurses' wound care knowledge

Wound care is an important realm of nurses' clinical responsibilities, and a broad knowledge and range of skills are needed to perform efficient and safe patient care. Nurses' knowledge on this matter can be measured using knowledge tests. This study aims to identify, define, and analyse the knowledge tests developed for the measurement of nurses' wound care knowledge, and to evaluate the psychometric properties of the tests. This study was a systematic literature review. A total of 52 studies and 18 instruments were found. Of the 18 instruments, only 5 had been used more than once and were successful in a psychometric evaluation. These five instruments were analysed on the basis of their psychometric properties by using Zwakhalen et al.'s (2006) psychometric testing framework. According to the analysis, the Pressure Ulcer Knowledge Test (PUKT) and the Pressure Ulcer Knowledge Assessment Tool (PUKAT) were the most valid and reliable instruments for measuring nurses' wound care knowledge. Most of the instruments identified and analysed focused on pressure ulcers, indicating that future instruments could focus more on other types of wounds or on wound care in general in order to receive a broader understanding of nurses' wound care knowledge

Reporting of Research Ethics in Studies Focusing on Foot Health in Patients with Rheumatoid Arthritis - A Systematic Review

Research ethics is a fundamental part of the entire research. Patients with rheumatoid arthritis are sensitive group of research participants because their long-term health problems cause significant changes in their foot health. In foot health research, data are usually collected through a clinical assessment of the foot or questionnaires. However, there is limited evidence of the reported research ethics of empirical studies on foot health in patients with rheumatoid arthritis. Therefore this review aimed to analyze the reported research ethics of peer-reviewed empirical studies focusing on foot health in patients with rheumatoid arthritis as research participants. This systematic review used the Medline/PubMed, CINAHL, and Embase databases. A total of 1,653 records were identified, and 32 articles were included in the final analysis. Reporting research ethics in studies of patients with rheumatoid arthritis is fragmented, focusing predominantly on ethical approval and informed consent and lacking a broader discussion about research ethics