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- Enhancing pressure ulcer prevention using wound dressings: what are the modes of action?Publication . Call, Evan; Pedersen, Justin; Bill, Brian; Black, Joyce; Alves, Paulo; Brindle, C. Tod; Dealey, Carol; Santamaria, Nick; Clark, MichaelRecent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench testing was performed using nine commercially available dressings. The use of dressings can reduce the amplitude of shear stress and friction reaching the skin of patients at risk. They can also effectively redirect these forces to wider areas which minimises the mechanical loads upon skeletal prominences. Dressings can redistribute pressure based upon their effective Poisson ratio and larger deflection areas, providing greater load redistribution.
- Systematic review of the use of prophylactic dressings in the prevention of pressure ulcersPublication . Clark, Michael; Black, Joyce; Alves, Paulo; Brindle, C. T.; Call, Evan; Deadley, Carol; Santamaria, NickThis systematic review considers the evidence supporting the use of prophylactic dressings for the prevention of pressure ulcer. Electronic database searches were conducted on 25 July 2013. The searches found 3026 titles and after removal of duplicate records 2819 titles were scanned against the inclusion and exclusion criteria. Of these, 2777 were excluded based on their title and abstract primarily because they discussed pressure ulcer healing, the prevention and treatment of other chronic and acute wounds or where the intervention was not a prophylactic dressing (e.g. underpads, heel protectors and cushions). Finally, the full text of 42 papers were retrieved. When these 42 papers were reviewed, 21 were excluded and 21 were included in the review. The single high-quality randomised controlled trial (RCT)and the growing number of cohort, weak RCT and case series all suggest that the introduction of a dressing as part of pressure ulcer prevention may help reduce pressure ulcer incidence associated with medical devices especially in immobile intensive care unit patients. There is no firm clinical evidence at this time to suggest that one dressing type is more effective than other dressing.
- Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countriesPublication . Beeckman, D.; Van den Bussche, K.; Alves, Paulo; Arnold Long, M.C.; Beele, H.; Ciprandi, G.; Coyer, F.; Groot, T. de; Meyer, D. de; Deschepper, E.; Dunk, A. M.; Fourie, A.; García-Molina, P.; Gray, M.; Iblasi, A.; Jelnes, R.; Johansen, E.; Karadağ, A.; Leblanc, K.; Dadara, Z. Kis; Meaume, S.; Pokorna, A.; Romanelli, M.; Ruppert, S.; Schoonhoven, L.; Smet, S.; Smith, C.; Steininger, A.; Stockmayr, M.; Damme, N. Van; Voegeli, D.; Hecke, A. Van; Verhaeghe, S.; Woo, K.; Kottner, J.Background Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. Objectives To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. Methods The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen’s kappa) were assessed. Results The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0 86 [95% confidence interval (CI) 0 86–0 87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0 55 (95% CI 0 55–0 56). The Fleiss kappa for differentiating between category 1 and category 2 was 0 65 (95% CI 0 65–0 65). The overall Fleiss kappa was 0 41 (95% CI 0 41–0 41). The Cohen’s kappa for differentiating between category 1 and category 2 was 0 76 (95% CI 0 75–0 77). The overall Cohen’s kappa was 0 61 (95% CI 0 59–0 62). Conclusions The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.
- The use of the R2 as a measure of firm-specific information: a cross-country critiquePublication . Alves, Paulo; Peasnell, Ken; Taylor, PaulRecent research uses the degree of stock returns co-movement as a measure of the quality of a country’s information environment. It has been argued that stronger property rights, better corporate governance regimes and more efficient enforcement mechanisms lead to prices incorporating more firm-specific information and, therefore, co-moving less with the market. In this paper, we use a much more comprehensive international data set than in prior research, encompassing forty countries over twenty years, to evaluate the reliability of this approach in a cross-country setting and to analyse the behaviour of the measure used. Our results demonstrate severe limitations in the use of co-movement as a measure of information quality. We highlight the instability of the measure and show that it can produce results that are often difficult to reconcile with such an informational explanation.
- Development and psychometric property testing of a skin tear knowledge assessment instrument (OASES) in 37 countriesPublication . Van Tiggelen, Hanne; Alves, Paulo; Ayello, Elizabeth; Bååth, Carina; Baranoski, Sharon; Campbell, Karen; Dunk, Ann Marie; Gloeckner, Mary; Hevia, Heidi; Holloway, Samantha; Idensohn, Patricia; Karadağ, Ayişe; Langemo, Diane; LeBlanc, Kimberly; Ousey, Karen; Pokorná, Andrea; Romanelli, Marco; Santos, Vera Lucia Conceição de Gouveia; Smet, Steven; Williams, Ann; Woo, Kevin; Van Hecke, Ann; Verhaeghe, Sofie; Beeckman, DimitriAim: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). Design: Prospective psychometric instrument validation study. Method: The skin tear knowledge assessment instrument was developed based on a literature review and expert input (N = 19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April–May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test–retest reliability (stability) were analysed and evaluated in light of international reference standards. Results: A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI = 0.90–1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01–0.52. The discriminating index was acceptable (0.19–0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p < .001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.78– 0.86) for the full instrument and varied between 0.72 (95% CI = 0.64–0.79) and 0.85 (95% CI = 0.81–0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. Conclusion: The skin tear knowledge assessment instrument is supported by acceptable psychometric properties and can be applied in nursing education, research, and practice to assess knowledge of healthcare professionals about skin tears. Impact: Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice, and research needs and priorities related to skin tears in clinical practice.
- Empoderamento psicológico em enfermagem – tradução, adaptação e validação do "Psychological Empowerment Instrument"Publication . Teixeira, Abílio Cardoso; Nogueira, Maria; Alves, PauloBACKGROUND: Professional Empowerment in Nursing has a positive impact on the nurse, the patient, the Health institutions and the subject of nursing itself and it is, therefore, of the utmost importance. AIM: The need for this study came from the absence of an instrument capable of measuring Empowerment validated for the Portuguese population (from a psychological perspective). We aimed to translate, adapt and validate the "Psychological Empowerment Instrument". METHODS: In a methodological study, through translation and back-translation, while using a stratified probability sample formed by nurses in a general hospital in Oporto, Portugal. RESULTS: Four factors were identified through the factor analysis coinciding with those identified by Spreitzer (1995). These factors explain 73,504% of the total variance of the scale and isolated they explain 24,459 (Meaning), 18,780 (Impact), 15,470 (Self-determination) and 15,028 (Competence). The reliability of the scale was estimated using Cronbach's alpha coefficient, with a total of 0,824 (the value of the different dimensions ranging from 0,688 to 0,868), and so we considered that this scale had internal consistency. We also verified a statistically significant correlation between different dimensions, varying Pearson’s correlation coefficients between 0.173 and 0.594. CONCLUSION: Therefore, we believe to have obtained a version of "Psychological Empowerment Instrument" valid for the sample under study.
- Monitorização de desconforto em pessoas com sensibilidade reduzida: prevenção de úlceras de pressãoPublication . Carvalho, M. A. F.; Santos, J. R.; Alves, P.; Fontes, L.; Ferreira, A.; Duarte, F. M.
- Attitude Towards Pressure Ulcers Instrument: validação e adaptação transcultural para a população portuguesa de enfermeirosPublication . Batista, Margarida; Dixe, Maria dos Anjos; Alves, PauloContexto/objetivos: A investigação e a prática têm evidenciado a importância das atitudes dos enfermeiros na prevenção das úlceras de pressão e a necessidade da elaboração de instrumentos de medida válidos e fiáveis para a sua avaliação. Respondendo a esta necessidade, procedemos à validação transcultural do Attitude Towards Pressure Ulcers Instrument (APU) para a população portuguesa. Metodologia: Realizou-se um estudo metodológico numa amostra não-probabilística de estudantes de enfermagem (n=147) e enfermeiros (n=155). Foi utilizada a metodologia usada no estudo de validação original. Resultados: A tradução-retrotradução com a participação de um painel de peritos garantiu a equivalência semântica e conceptual. A análise fatorial determinou que os 22 itens se organizam em 5 fatores (importância, responsabilidade, obstáculos/barreiras, confiança na eficácia e competências pessoais), explicando 53,6% da variância total. Obteve-se um poder descriminante da escala em alguns dos grupos comparados. O coeficiente a Cronbach total=0,847 garantiu a consistência interna da escala e a confiabilidade teste-reteste revelou coeficientes de correlação r=0,883 comprovando a sua estabilidade temporal. Enfermeiros e estudantes revelaram uma atitude positiva acerca dos itens da escala, sem diferença estatisticamente significativa entre estes (t=0,567; p>;0,05). Conclusão: A escala APu-PT evidenciou ser fiável e válida para a prática, ensino e investigação.
- Skin temperature as a clinical parameter for nursing care: a descriptive correlational studyPublication . Soares, Rhea S.A.; Lima, Suzinara B.S.; Eberhardt, Thaís D.; Rodrigues, Liane R.; Martins, Robson S.; Silveira, Lidiana B. T. D.; Alves, Paulo J. P.Objective: To identify the skin temperature in different body areas of hospitalised individuals in the surgical unit, without risk of developing a pressure ulcer (PU). Methods: A descriptive, correlational and cross-sectional study, carried out May–October 2017, in a surgical unit of a university hospital in southern Brazil. Temperature was measured at the bony prominences including scapula, elbow, trochanters and heels, on both sides of the body, as well as occipital and sacral regions. Results: A total of 230 patients took part in the study. All regions of the body measured presented differences in temperatures. The sacral region presented the highest mean temperature (34.2±0.1°C). Patients (aged 18–59 years) had higher skin temperatures in the sacral region than older patients (aged 60–88 years). There was a symmetry in temperatures on both sides of the body. There was a low degree of correlation between age, room temperature, room humidity and skin temperature in some body regions. Conclusion: The study established mean values for skin temperature in specific body regions in patients without risk of developing a PU, hospitalised in a surgical unit. It also demonstrates how skin temperature can be used as a clinical parameter in practice to support the prevention of PUs.
- Community-dwelling elderly: ineffective management of drug regimen and risk fallPublication . Costa, Tânia; Pinto, Catarina; Afonso, Diogo; Almeida, Armando; Silva, Rosa; Coelho, Patrícia; Alves, PauloIntroduction: Drugs intake is common in the elderly, but pharmacodynamics/pharmacokinetic changes associated with multiple pathologiy amplifys the drug interactions and adverted effects. Objectives: Evaluate the management of drug regimen for the elderly residing at home (N=37), relating it to falls. Methods: Data collection was carried out by semi-structured interview (using instruments validated for the Portuguese reality) followed by descriptive/inferential analysis. Insured informed consent. Results: Average of drug ingestion was 6 drugs/day(min:2 /max:6) and 7 pills/day (min:2 /max:15),. A total of 9 prescribers were described: family physician (N=32), the hospital physician (N=26), the pharmacist (N = 6) and the elderly (N = 6). The reasons why we found that 25 elderly do not meet treatment as prescribed, was due to forgetfulness (68 %) and switching medications (23%). The management of medication regimen presents statistically significant differences compared to moderate/high risk of falling (þ=0.030), dependence in activities of daily living (þ=0.008), geriatric depression (þ=0.022), number of pills/day (þ=0.006) and number of diferent drugs (þ=0.009). The risk of falling, in other way, is related to cognitive impairment (þ=0.032), dependence in instrumental activities of daily living (þ=0.005) and number of pills/day (þ=0.043). Conclusion: Data seem indicate that there is a proportional relationship between fall risk and ineffective management of medication regimen. Considering the prevalence of falls in the elderly and it’s repercussions, highlights the need to implement nursing care of proximity/partnership, but also, integrals and integrated in both diagnoses, especially in the context of primary health care.