Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Health and social care educators’ ethical competence

Abstract Background and purpose: Educators’ ethical competence is of crucial importance for developing students’ ethical thinking. Previous studies describe educators’ ethical codes and principles. This article aims to widen the understanding of health- and social care educators’ ethical competence in relation to core values and ethos. Theoretical background and key concepts: The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. Methods: Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. Ethical considerations: The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. Findings: The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. Conclusion: Educators’ personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators’ training regarding ethical competence

Täydennyskoulutustarpeet ja täydennyskoulutuksen merkitys uransa alussa olevien sosiaali-, terveys- ja kuntoutusalan ammattikorkeakouluopettajien osaamiselle

Abstract Up-to-date competences of educators in the social, health care and rehabilitation sector in universities of applied sciences are crucial for top-quality education. The purpose of this research was to describe the needs and meanings of continuing education for teachers starting their career. This study is a part of a national TerOpe project. The method of data collection was a theme interview. The interviews were arranged to four teacher groups consisting of 2—5 people. The people interviewed (n=14) were educators of nursing, fysiotherapy and social work on three universities of applied sciences located in different parts of Finland. The data were analysed with inductive content analysis. Those teachers who had less than five years of teacher experience wanted to have further education which answered to individual learning needs, were useful, included collegial interaction and were of high-quality pedagogically. Teachers also felt they need possibilities for development of their work organized by their employer, such as job orientation, supervision and mentoring. Teachers felt that they need to develop their own work, co-operation competence and they need personal professional development, and development of teaching competence and digital competence. The meaning of further education for teachers was diverse ways of gaining of professional knowledge and improvement on personal working abilities. The results can be used for the design and development of continuing education for social and health care teachers in the beginning of their career in universities of applied sciences.Tiivistelmä Sosiaali-, terveys- ja kuntoutusalan ammattikorkeakouluopettajien ajantasainen osaaminen on edellytys laadukkaalle koulutukselle. Tutkimuksen tarkoituksena oli kuvata uransa alussa olevien sosiaali-, terveys- ja kuntoutusalan opettajien täydennyskoulutustarpeita sekä täydennyskoulutuksen merkitystä heidän osaamiselleen. Tutkimus on osa valtakunnallista TerOpe hanketta. Aineistonkeruumenetelmänä oli teemahaastattelu. Haastattelut toteutettiin neljälle 2—5 hengen opettajaryhmälle. Haastateltavat (n=14) olivat hoitotyön, fysioterapian ja sosionomin koulutusohjelmien opettajia kolmesta eri ammattikorkeakoulusta eri puolilta Suomea. Aineisto analysoitiin induktiivisella sisällönanalyysilla. Alle viisi vuotta opettajana toimineet haastateltavat toivoivat tarvetta vastaavaa täydennyskoulutusta, joka on itselle hyödyllistä, sisältää kollegiaalista vuorovaikutusta ja on pedagogisesti laadukasta. Opettajat kokivat tarvitsevansa työnantajan tarjoamia työssä kehittymisen mahdollisuuksia kuten perehdytystä, työnohjausta ja mentorointia. Opettajana kehittymiseen he arvioivat tarvitsevansa oman työn ja yhteistyöosaamisen kehittämistä, henkilökohtaista ammatillista kasvua sekä opetusosaamisen ja digiosaamisen kehittymistä. Täydennyskoulutus merkitsi uransa alussa olevien opettajien osaamiselle ammattitaidon kehittymistä ja henkilökohtaisten työskentelyvalmiuksien vahvistumista. Tuloksia voidaan hyödyntää uransa alussa olevien ammattikorkeakouluopettajien ammatillisen kehittymisen ja täydennyskoulutuksen suunnittelussa ja kehittämisessä

Qualitative study of social and healthcare educators’ perceptions of their competence in education

Abstract Competent educators are needed to ensure that social and healthcare professionals are effective and highly competent. However, there is too little evidence‐based knowledge of current and required enhancements of educators’ competences in this field. The aim of this study was to describe social and healthcare educators’ perceptions of their competence in education. The study had a qualitative design, based on interviews with educators and rooted in critical realism. Forty‐eight participants were recruited from seven universities of applied sciences and two vocational colleges in Finland, with the assistance of contact persons nominated by the institutions. The inclusion criterion for participation was employment by an educational institution as a part‐time or full‐time, social and/or healthcare educator. Data were collected in the period February–April 2018. The participants were interviewed in 16 focus groups with two to five participants per group. The acquired data were subjected to inductive content analysis, which yielded 506 open codes, 48 sub‐categories, nine categories and one main category. The educators’ competence was defined as a multidimensional construct, including categories of educators’ competences in practicing as an educator, subject, ethics, pedagogy, management and organisation, innovation and development, collaboration, handling cultural and linguistic diversity, and continuous professional development. Educators recognised the need for developing competence in innovation to meet rapid changes in a competitive and increasingly global sociopolitical environment. Enhancement of adaptability to rapid changes was recognised as a necessity. The findings have social value in identifying requirements to improve social and healthcare educators’ competence by helping educational leadership to improve educational standards, construct a continuous education framework and create national and/or international curricula for teacher education degree programs to enhance the quality of education. We also suggest that educational leadership needs to establish, maintain and strengthen collaborative strategies to provide effective, adaptable support systems, involving educators and students, in their working practices

Competence areas of health science teachers:a systematic review of quantitative studies

Abstract Background: In the face of rapid digitalisation and ever-higher educational requirements for healthcare professionals, it is important that health science teachers possess the relevant core competences. The education of health science teachers varies internationally and there is no consensus about the minimum qualifications and experience they require. Objective: The aim of this systematic review was to describe the health science teachers’ competences and the factors related to it. Design: Systematic review of original quantitative studies. Data sources: Four databases were selected from which to retrieve original studies: Cinahl (Ebsco), PubMed, Medic, Eri (ProQuest). Review Methods: The systematic review used PICOS inclusion criteria. Original peer-reviewed quantitative studies published between 1/2007 and 1/2018 were identified. Screening was conducted by two researchers separately reading the 1885 titles, 600 abstracts, and 63 full-texts that were identified, and then agreed between them. Critical appraisal was performed using the JBI MAStARI evaluation tool. The data was extracted and then analysed narratively. Results: The core competences of health science teachers include areas of knowledge, skills and attitudes. Health science teachers evaluate their own competence as high. Only in relation to entrepreneurship and leadership knowledge was evaluated to be average. The most common factors influencing competence were teachers’ title/position, healthcare experience, research activities, age, academic degree and for which type of organisation they work. Conclusion: It is important to identify the core competencies required by health science teachers in order to train highly competent healthcare professionals. Based on the findings of this systematic review we suggest that teachers should be encouraged to gain university education and actively participate in research, and that younger teachers should have opportunities to practice the relevant teaching skills to build competence

Development and testing of an instrument (HeSoEduCo) for health and social care educators’ competence in professional education

Abstract Background: Health and social care education is highly important for preparing future professionals for their future roles in sustainable health and social care. However, previous studies have emphasized that health and social care educators’ competence is complex and poorly defined. Thus, there is a clear need for a psychometrically validated instrument to enable clarification and assessment of the required skills. Objective: To develop and psychometrically validate an instrument (the HeSoEduCo) for assessing health and social care educators’ competence in higher and professional education. Design: Cross-sectional study. Methods: A HeSoEduCo instrument, with items inviting 1–4 Likert scale responses, was developed, based on one systematic review and one qualitative study, then validated in terms of face, content and construct validity and internal consistency (Cronbach′s alpha values). All health and social care educators based in all 21 universities of applied sciences in Finland and seven vocational colleges were subsequently invited to participate in a large-scale application of the instrument in fall 2018. In total, responses of 390 of these educators are analyzed here. Results: The face and content validity of 71 newly developed items were assessed by experts in two evaluation rounds. The final content validity showed high scores for the instrument’s relevance and clarity. Confirmatory factor analysis (to test construct validity) yielded eight factors (43-items remaining), defining the following competence areas of educators: evidence-based practice, digital collaborative learning, student-centered pedagogy, collaboration & societal, leadership & management, cultural & linguistic diversity, mentoring student into professional competence development and subject & curriculum. Cronbach’s alpha values for the factors ranged from 0.70 to 0.89. Conclusion: The instrument can be used to obtain self-evaluations of educators’ competence when assessing their general competence levels and help human resources departments and managers to identify suitable continuous education programs for their staff

Sosiaali-, terveys- ja kuntoutusalan opettajien itsearvioitu osaaminen

Tiivistelmä Tutkimuksen tarkoituksena oli kuvata sosiaali-, terveys- ja kuntoutusalan (soteku) opettajien itsearvioitua osaamista. Lisäksi selvitettiin koulutusalojen ja koulutusorganisaatioiden välisiä eroja opettajien itsearvioidussa osaamisessa. Tutkimus oli osa ”Osaavat opettajat yhdessä!” TerOpe– OKM -kärkihanketta. Kohderyhmä muodostui 21 ammattikorkeakoulun ja seitsemän ammatillisen oppilaitoksen opettajista (n=422). Tutkimusaineistona hyödynnettiin TerOpe-hankkeen HeSoEduCo-mittarilla (1–4 Likert-asteikko) hankkimaa aineistoa, joka mittasi opettajien itsearvioitua osaamista kahdeksalla osaamisalueella. Aineisto analysoitiin tilastollisin menetelmin Mann Whitneyn U- ja Kruskal Wallis-testeillä. Opettajat arvioivat osaamisensa hyvälle tasolle. Vahvin osaaminen muodostui opiskelijan ammatillisen kehittymisen ohjausosaamisesta ja heikoin osaaminen yhteisöllisestä digipedagogiikasta. Terveysalan opettajien näyttöön perustuvan toiminnan osaaminen oli sosiaalialan ja yhdistettyjen alojen opettajia parempi. Sosiaalialan opettajien substanssi- ja opetussuunnitelmaosaaminen sekä verkosto- ja yhteiskunnallinen osaaminen olivat terveysalan opettajien osaamista vahvempia. Yhdistettyjen alojen opettajien opiskelijalähtöinen pedagoginen sekä verkosto- ja yhteiskunnallinen osaaminen oli ter veysalan opettajien osaamista parempi. Ammattikorkeakoulujen opettajien osaaminen oli ammatillisten oppilaitosten opettajien osaamista parempi opiskelijalähtöisen pedagogiikan, yhteisöllisen digipedagogiikan, kulttuurisen osaamisen, johtamis- ja hallinnollisen sekä näyttöön perustuvan toiminnan osalta. Tuloksia voidaan hyödyntää ammattikorkeakoulujen ja ammatillisten oppilaitosten johtamisessa sekä soteku-alan perus- ja täydennyskoulutuksessa.Abstract The purpose of the study was to describe the competence of social-, health care, and rehabilitation educators based on their evaluations. Differences between educational organizations and work organizations in the competencies of educators were also investigated. The study was part of the ”Competence educators together!” TerOpe project which was funded by the Ministry of Education and Culture in Finland. The target group consisted of educators from 21 universities of applied sciences and seven vocational institutes (n=422). The data was collected with a HeSoEduCo instrument (1–4 Likert scale) in the autumn of 2018 by the team of TerOpe project. The instrument measured educators’ self-assessed competence in eight areas of competence. The data were analyzed using statistical methods. Educators evaluated their competence at a good level. The highest competence consisted of mentoring students into professional development competence and the lowest of competence of digital collaborative learning. The evidence-based competence of health care educators was better than the competence of social care and combined fields’ educators. Subject and curriculum competence, as well as collaboration and societal competence of social care educators, were higher than those of health care educators. The student-centered pedagogy, collaboration, and societal competencies of the educators of the combined fields were better than those of the health care educators. Competence of universities of applied sciences educators was higher than those of vocational college’ educators in terms of student-centered pedagogy, digital collaborative learning, culture, leadership and management, and evidence-based practice competence. The results can be used in the management of the university of applied sciences and vocational colleges, as well as in basic and continues education in the social-, health care, and rehabilitation fields

Social, health care and rehabilitation educator’ competence in professional education:empirical testing of a model

Abstract The social and health care educator’s role in educating future professionals need to be stronger emphasised and deserves international recognition. The purpose of this study was to develop and test an empirical model of social and health care educators’ competence in higher and professional education. The presented research employed a cross-sectional study design. Data were collected using HeSoEduCo-instrument from 28 educational institutions in Finland. The model was empirically tested with confirmatory factor analysis through Structural Equation Modelling that applied the Full Imputation Maximum Likelihood estimator. A total of 422 social and health care educators participated in the study. The empirical model of social and health care educators including eight competence areas: leadership and management, collaboration and societal, evidence-based practice, subject and curriculum, mentoring students in professional competence development, student-centred pedagogy, digital collaborative learning, and cultural and linguistic diversity. All of the connections between concepts of the empirical model were found to be statistically significant. There were strong connections between most of the identified competence concepts; however, two weak connections were found, namely, the link between competence in evidence-based practice and competence in subject and curriculum, along with the link between competence in digital collaborative learning and competence in student-centred pedagogy. The presented empirical model can help stakeholders identify which areas of social and health care educators’ curricula should be further developed. The model is also relevant for improving continuous education, allowing educators to assess their competence levels and evaluating educators’ performance at the organisational level