Using Cognitive Pre-Testing Methods in the Development of a New Evidenced-Based Pressure Ulcer Risk Assessment Instrument

Background: Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056). This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods: A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results: Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions: The pre-test was an important step in the development of the preliminary PURPOSE-T and the methods used may have wider instrument development application. PURPOSE-T proposes a new approach to pressure ulcer risk assessment, incorporating a screening stage, the inclusion of skin status to distinguish between those who require primary prevention and those who require secondary prevention/treatment and the use of colour to support pathway allocation and decision making. Further clinical evaluation is planned to assess the reliability and validity of PURPOSE-T and it’s impact on care processes and patient outcomes

Mass-resolved ion energy measurements at both electrodes of a 13.56 MHz plasma in CF4

The ion energy distributions (IEDs) at the electrodes in a capacitively coupled 13.56 MHz plasma in CF4 have been measured mass resolved with a Balzers quadrupole in combination with a home-built energy analyzer. Mass-resolved determination offers the possibility to compare the IED of different ions achieved in the same sheath. The IEDs have been determined at both the largest and the smallest electrode. Apart from the IEDs of the CF4 species, the IEDs of ionic species in plasmas in argon and nitrogen also were determined. Apart from the CF4 ionic species CF+3, CF+2, CF+, and F+, CHF+2 ions also are present in the CF4 plasma due to residual water in the reactor. Because the CHF+2 ions are not produced in the sheath and because we do not detect elastically scattered ions, the IEDs of these ions show the typical bimodal distribution for rf plasmas which corresponds to an IED of ions which have not collided in the sheath. From these IEDs we can obtain the sheath characteristics, such as the averaged sheath potential. From the IEDs of CF+n ions one can conclude that, in the sheath of the CF4 plasma, a large number of chemical reactions takes place between the CF+n ions and the neutrals