To Örebro University

OBJECTIVE: The objective of this scoping review is to map the existing evidence on the epidemiology, care challenges, and impacts of various wound types among individuals living with dementia across different stages of the disease.

INTRODUCTION: Dementia is a growing global health concern, projected to rise significantly as the population ages. This condition not only affects cognitive function but also increases the risk of chronic wounds in part due to impairments in mobility, self-care, and communication. Current wound care guidelines inadequately address the specific needs of individuals with dementia. This scoping review seeks to fill this gap by comprehensively exploring the intersection between dementia and wound care.

INCLUSION CRITERIA: This review will include studies involving adults aged 18 and older diagnosed with dementia or cognitive impairment who are experiencing alterations in skin integrity, such as pressure injuries, venous and arterial ulcers, and diabetic ulcers. Both qualitative and quantitative studies will be considered, as well as studies focusing on the challenges faced by caregivers in managing wounds in this population. Excluded are studies such as editorials and opinion articles.

METHODS: A comprehensive search strategy will be employed across multiple electronic databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and PubMed, as well as grey literature sources like ProQuest Dissertations & Theses Global and OpenGrey. The search will include studies published in English and French without date restrictions. Data will be extracted using a pilot-tested tool and presented in graphical, diagrammatic, and tabular formats. A narrative summary will accompany these visuals, providing context and insights into the data in relation to the review's objectives.

AIMS: The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium.

DESIGN: A co-design development process was conducted.

METHODS: This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants.

RESULTS: A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter.

CONCLUSION: The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come.

IMPLICATIONS FOR THE PROFESSION: This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging.

IMPACT: What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses.

REPORTING METHOD: The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.

OBJECTIVES: This study aimed to assess and analyze nurses' knowledge regarding Skin Tears (STs).

METHODS: An observational, exploratory, and cross-sectional study was conducted across four hospitals in São Paulo, Brazil, encompassing diverse settings: two public hospitals (one affiliated with a university and the other serving state public service professionals) and two private hospitals (one specializing in highly complex cases and the other a general hospital). Data collection involved two instruments: one for sample characterization and another, the OASES instrument, which was translated and content-validated for use in Brazilian Portuguese, to assess nurses' knowledge on STs. Data were analyzed using measures of central tendency and variability.

RESULTS: The study included 179 nurses, with an average score of 10.83 (SD = 3.32). Higher knowledge levels were observed in nurses who had received training on STs (p = 0.003) and those who participated in scientific activities (p < 0.001).

CONCLUSIONS: Nurses across the four hospitals in São Paulo demonstrated a level of knowledge about STs that was slightly higher compared to international benchmarks in similar studies.

AIMS: Exemplify the potential of using health economy modeling and simulations to support and optimize wound dressing purchasing decisions.

MATERIALS AND METHODS: We developed a Markov cost-effectiveness modeling framework fusing clinical and industry sources of healing and cost outcomes for evaluating dressings, focusing on polymeric membrane dressings compared to passive foam dressings without active inflammation modulation components. We calculated the wound care costs for patients with and without diabetes, as well as for infected and non-infected wounds, to illustrate the effectiveness of this model in supporting decision-making.

RESULTS: The model results demonstrated that polymeric membrane dressings reduce the cumulative treatment costs compared to passive foam dressings, due to fewer dressing changes and lower associated labor costs, regardless of the initial product price differences.

CONCLUSION: Cost-effectiveness calculations should be performed in healthcare facilities to support purchasing decisions based on true cost analyses. Making purchasing decisions focusing on the dressing price alone may provide wrong estimates of the real cost differences.

BACKGROUND: Incontinence-associated dermatitis (IAD) poses a significant challenge for individuals experiencing incontinence, characterized by irritative contact dermatitis due to prolonged exposure to urine and/or faeces.

OBJECTIVE: This study aimed to culturally adapt the Ghent Global IAD Monitoring Tool - GLOBIAD-M to Brazilian Portuguese and to assess the adapted version's measurement properties quality.

METHOD: A clinimetric study was conducted, comprising cultural adaptation and psychometric assessment. Cultural adaptation followed international guidelines, while psychometric properties were evaluated for content validity, inter-rater reliability, and correlation with other variables (thermography). Inter-rater reliability was assessed through clinical and photographic evaluations. The study samples included linguists and, IAD specialists, nurses, and adult patients with IAD according to the cultural adaptation or psychometric evidence assessment.

RESULT: The process of cultural adaptation resulted in a cumulative coefficient of variation ratio (CVR) of 0.66. Subsequently, the study included 57 patients and 57 nurses for clinical assessments, totalling 166 evaluations of IAD. The inter-rater reliability among nurses was deemed satisfactory, with a Gwet coefficient of 0.77. Moreover, out of 215 photographic assessments conducted by 54 nurses, there was a 92.1 % concurrence in the categorization of IAD. Furthermore, thermography analysis revealed significant temperature differences between healthy individuals and those with IAD, particularly in patients categorized under IAD Cat. 1B, showing a difference of 1.90 °C.

CONCLUSION: and Impact on Clinical Practice: The results confirm the availability of the GLOBIAD-M in its Brazilian Portuguese version. This tool will allow health professionals to obtain a standardized IAD classification and monitoring in Brazil, enhancing its diagnostic accuracy and aiding clinical decision-making.

STUDY DESIGN: Guideline adaptation study using the ADAPTE method.

OBJECTIVE: The aim of this study was the development and validation of a Danish clinical practice guideline for PU/PI prevention and treatment for people with SCI through adaptation of existing guidelines.

METHODS: The ADAPTE method is a systematic framework used to adapt existing clinical practice guidelines to a new context, such as a different healthcare setting or population. This method ensures that the adapted guidelines are relevant, evidence-based, and practical for the specific context in which they will be implemented.

SETTING: Relevant stakeholders and treatment units within the Danish healthcare system involved in the rehabilitation, treatment, and care of people with SCI.

RESULTS: The adaptation yielded 22 topics and 121 recommendations, which underwent external review. Stakeholders gave positive feedback and qualified the recommendations. However, they also highlighted challenges in implementation due to the complexity of PU/PI prevention and treatment and organizational issues within the Danish healthcare system.

CONCLUSIONS: This study has resulted in the development of a comprehensive Danish clinical practice guideline tailored specifically for the prevention and treatment of PU/PI among people with SCI within the Danish healthcare system. The external review emphasizes the imperative for continuous research aimed at strengthening evidence-based approaches to both prevention and treatment. Furthermore, it highlights the necessity for systematic dissemination strategies to facilitate the integration of the guideline into clinical practice.