To Örebro University

BACKGROUND: Wound cleansing is a fundamental component of chronic wound management; yet, high-quality evidence to guide practice is limited. Understanding nurses' knowledge, attitudes, and practices (KAP) is essential, but no instrument with published evidence of acceptable measurement properties exists.

OBJECTIVE: To develop a KAP questionnaire on wound cleansing for community nurses and evaluate its measurement properties.

METHODS: A multi-phase study was conducted, including literature/consensus item generation; a two-round international Delphi process; pilot cognitive interviews; and field testing in Canada. Knowledge was assessed for item and construct validity; attitude for internal consistency (Cronbach's α); and all KAP items for stability using test-retest reliability.

RESULTS: 26 experts supported content relevance; feedback led to targeted revisions. Field testing involved 130 nurses (83.1 % homecare; >80 % with ≥5 years of wound care experience). Several knowledge items were too easy (≥.90); none negatively discriminated. Exploratory principal components analysis of attitudes yielded three components (63 % of variance); internal consistency ranged from α = 0.41 to α = 0.76. In the subsample (n = 30), knowledge κ values ranged from slight/fair to substantial; some items showed ceiling effects (uniform responses, κ undefined). Attitude and practice item-level intraclass correlation coefficients varied (.07-.95), with several ≥.75 and others <.60. Known-groups comparison supported higher knowledge among formally educated nurses.

CONCLUSION: Evidence supports content validity and a clarified attitudes structure; internal consistency and stability were acceptable for some elements but below the threshold for others. Future refinement and confirmatory testing are warranted.

BACKGROUND: Practical nursing skills are complex actions performed daily in nursing practice. Structured learning and repeated practice help students develop clinical competence. Clinical placements are pivotal in learning, with factors such as educational context, preceptor availability, and time constraints shaping students' learning opportunities.

OBJECTIVES: To describe nursing students' opportunities to perform practical skills during clinical placements.

DESIGN AND SETTING: A quantitative cross-sectional study conducted in 2023 involved 706 nursing students from Denmark, Norway, and Sweden. Data were collected via a questionnaire and analyzed using descriptive statistics. RESULTS: Students reported substantial variations in the practical skills performed during clinical placements. Overall, the frequency of skills performance was low across all years and domains, including practical nursing skills concerning respiration, circulation, elimination, nutrition, activity, skin care, and medication. Supervision was generally available, though some skills lacked adequate preceptor involvement.

CONCLUSIONS: The study highlights disparities in nursing students' opportunities to practice essential skills during clinical placements. The lack of practice across a wide range of skills may compromise the quality and thoroughness of nursing education, affecting the students' professional preparedness.

INTRODUCTION: Supervision of degree theses is a central activity in Higher Education. Writing a Bachelor thesis (BT) is often described as a challenging process for undergraduate nursing students. Previous research on academic supervision has primarily focused on individual aspects at the master's and doctoral levels rather than nursing teachers' experiences of BT supervision.

OBJECTIVE: This study explores nursing teachers' experiences of Bachelor thesis group supervision in nursing education.

METHODS: Semi-structured interviews were conducted with nursing teachers from four universities in the middle of Sweden. The data were analysed using reflexive thematic analysis.

RESULTS: The overall theme of the analysis is Different ways of organising and structuring supervision, supported by two subthemes: Finding and developing one's role as a supervisor and Promoting students' academic learning. Supervisors shape their roles through guidelines, syllabi, insights from colleagues, co-supervision, and personal experience. Supervisors feel a strong sense of personal responsibility and co-responsibility for their students' progress. Flexibility is necessary, as not everything can be standardised.

CONCLUSION: The findings underscore the complexity of the supervisory role and the need for clear organisational frameworks, while flexibility and personal adaptation are key to supporting students effectively. The development of pedagogical supervisory skills is an ongoing process, and organisational support plays a critical role in ensuring supervisors can feel satisfaction and continue to develop in their roles.

AIM: To explore the prerequisites for operating room nurses to carry out infection prevention interventions during the intraoperative phase.

DESIGN: Integrative review.

REVIEW METHOD: Whittemore and Knafl's method guided this integrative review. Database searches were conducted in PubMed, CINAHL, EBSCO, Embase and Web of Science's Core Collection. The initial search took place on April 12, 2022, with complementary searches on November 11, 2024.

RESULTS: Four categories emerged from the analysis of the 18 included studies. These categories encompassed the intrapersonal prerequisites of the operating room nurses, interpersonal prerequisites within the operating room team, adherence to guidelines and supportive conditions.

CONCLUSIONS: Prerequisites for infection prevention interventions during the intraoperative phase included the professional competence of operating room nurses, a supportive team and sufficient resources provided by management, such as adequate equipment and time for planning and implementation. Ensuring patient safety requires operating room nurses to embrace their leadership roles and adhere to evidence-based recommendations.

REPORTING METHOD: The PRISMA 2020 statement.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: For patient safety, management should strive to ensure that the necessary prerequisites are in place to provide safe intraoperative infection prevention.

IMPACT: This study offers valuable insights for the global community of operating room nurses, operating room team members and managers regarding the essential prerequisites for safe infection prevention for vulnerable patients during the intraoperative phase. No patient or public contribution was included in this study.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this study.

Aim: To explore operating room nurses' self-estimated knowledge and attitudes regarding the prevention of intraoperative pressure ulcers.

Background: Pressure ulcers are a significant patient safety concern in surgical settings. Despite being largely preventable, intraoperative pressure ulcers continue to occur due to prolonged immobility, positioning and device-related pressure. Nurses play a critical role in pressure ulcer prevention, yet knowledge gaps and unclear responsibilities may hinder effective practice.

Design: A cross-sectional study using a quantitative online survey conducted in accordance with STROBE guidelines.

Methods: An online self-reporting survey was distributed to 1904 eligible operating room nurses across Sweden. A total of 284 operating room nurses responded (response rate 15%). The survey included two validated instruments: the Pressure Ulcer Knowledge Assessment Tool-Operating Room (PUKAT 2.0 OR) and the Attitudes toward Pressure Ulcer Prevention-Operating Room (APuP-OR). Descriptive and non-parametric statistics were used to analyse the data.

Results: Participants displayed solid knowledge of pressure ulcer aetiology, but their understanding of preventive strategies, particularly those related to intraoperative positioning, was markedly weaker. Attitudes towards prevention were consistently positive, and participants generally expressed confidence in their ability to prevent pressure ulcers. Nonetheless, a substantial proportion indicated a continued need for further education in preventive measures.

Conclusion: Despite generally positive attitudes, operating room nurses' knowledge remains insufficient, especially regarding intraoperative positioning. Strengthening pressure ulcer prevention in surgical teams therefore requires structured educational initiatives and clearer role clarification of responsibilities within the surgical team. It is essential to enhance pressure ulcer prevention and improve patient safety.

Implications for Nursing Practice: Operating room nurses' positive attitudes towards pressure ulcer prevention provide a strong foundation for practice improvement. Targeted evidence-based education, competency assessments and enhanced interprofessional collaboration may strengthen preventive practices, reduce intraoperative pressure ulcers and improve patient safety during surgery.

Patient or Public Contribution: There was no patient or public contribution.

BACKGROUND: Missing nursing care in the perioperative context affects quality of care and patient safety. More validated language versions of the MISSCARE Survey OR enable local, national, and international comparisons. The aim was to translate and culturally adapt the American MISSCARE Survey OR to the Swedish perioperative context and assess the instrument's psychometric properties.

METHODS: A cross-sectional validation study with translation and cultural adaptation was conducted in eight steps according to the International Society for Pharmacoeconomics and Outcomes Research guidelines. To assess the psychometric properties, data were collected via a web survey distributed at a Swedish national conference for operating room nurses. The data collection was concluded in November 2023. Acceptability, construct validity and internal consistency were analyzed.

RESULTS: Cultural adaptation resulted in the omission of two items from the section measuring missed elements of care. A total of 107 (out of 261 invited operating room nurses) respondents were included in the psychometric testing, leading to a response rate of 41%. Acceptability was high, and 95.3% of the respondents answered all the items. The factor analysis on missed elements of care was inconclusive and was therefore regarded as a list of nursing actions. With respect to reasons for missed nursing care, the factor analysis resulted in a three-factor solution, which explained a cumulative variance of 62.6%. The alpha coefficients for internal consistency for the three factors ranged from 0.760 to 0.947.

CONCLUSIONS: The Swedish MISSCARE Survey OR is a valid instrument with sufficient psychometric properties and provides a reliable measure of missed nursing care and its reasons. Usage could be valuable for nursing managers and directors, who are responsible for care processes and strategic care planning.

BACKGROUND: Surgical site infections are a significant threat to patient safety. Shoulder arthroplasty carries an increased risk due to foreign implants. Skin preparation in general is a key preoperative preventive intervention, and the use of chlorhexidine can have a prolonged effect on bacterial colonisation. There is a lack of evidence regarding whether postoperative disinfection has an impact on bacterial colonisation during the first 48 hours after surgery. Our hypothesis was that applying postoperative antiseptic with 5 mg/ml chlorhexidine in 70% ethanol would lead to reduced bacterial colonisation with Staphylococcus aureus, coagulase-negative staphylococcus and Cutibacterium acnes around the surgical wound within the initial 48 hours after elective shoulder surgery, compared with the use of sodium chloride.

METHODS: A single-blinded, controlled study was conducted at a county hospital in Sweden. Swabs from the skin were collected four times: at baseline, preoperatively, after the intervention and after 48 hours.

RESULTS: Our hypothesis was not confirmed. Although not statistically significant, the chlorhexidine group had a higher prevalence of bacterial colonisation of clinically relevant bacteria.

CONCLUSIONS: Our study could not confirm that postoperative disinfection with chlorhexidine reduces bacterial colonisation compared with sodium chloride. The results highlight the complexity of SSIs and the importance of evidence-based preventive skin preparation to ensure patient safety. Further research is needed, considering the study's limitations, to explore and evaluate the effectiveness of different skin cleansing solutions and preventive strategies in diverse surgical contexts.

BACKGROUND: Writing a bachelor thesis has a central role in nursing education. Nursing students require both information and academic literacy in order to write their theses, and there is an expectation that these skills will contribute to putting their knowledge into practice.

OBJECTIVES: To describe students' perceptions of the student and supervisor roles and to investigate students' experienced self-efficacy during the supervision of their bachelor thesis.

DESIGN: A cross-sectional pre-post design.

SETTINGS: Four universities were included. All four had bachelor thesis courses organized as a group supervision process, with a student active approach. Nursing students met together one hour prior to meeting with their supervisor, in order to discuss concerns, try to solve upcoming problems, and plan the agenda for the upcoming supervision session.

PARTICIPANTS: A total of 472 undergraduate nursing students were invited to participate.

METHODS: A web-based questionnaire was used, incorporating the Supervision of Thesis Questionnaire and the General Self-Efficacy Scale. Data were collected at two points: before and after the thesis course. Descriptive statistics and frequencies were calculated, and the independent t-test and Mann-Whitney U test were used for analytic analysis.

RESULTS: The response rate was 39 % (160/472) pre-course and 28 % (130/472) post-course. Nursing students had high expectations of supervision at both time points. Students reporting high self-efficacy had higher expectations of the supervisor's knowledge of the subject and the methods, compared to those reporting lower self-efficacy.

CONCLUSIONS: Nursing students reported high expectations for the supervision process, the supervisor, and themselves, both when entering and when ending the bachelor thesis course. Self-efficacy may contribute to these expectations. Active learning in a group (i.e., collaborative learning) may contribute to nursing students' commitment during the group supervision process in a bachelor thesis course. Further studies are warranted on the optimal group composition to support learning during bachelor thesis courses.

INTRODUCTION: Surgical site infection after saphenous vein harvest is common, with reported leg wound infection rates ranging from 2 to 24%. There have been few investigations into sex-related differences in complication rates. Moreover, varied effects of smoking have been reported. The aim of this study was to investigate risk factors such as gender and smoking, associated with surgical site infection after vein graft harvesting in coronary artery bypass grafting surgery.

METHODS: We included 2,188 consecutive patients who underwent coronary artery bypass grafting surgery with at least one vein graft at our centre from 2009 to 2018. All patients were followed up postoperatively. Risk factors for leg wound infection requiring antibiotic treatment and surgical revision were analysed using logistic regression analysis.

RESULTS: In total, 374 patients (17.1%) received antibiotic treatment and 154 (7.0%) underwent surgical revision for leg wound infection at the harvest site. Female sex, high body mass index, diabetes mellitus, longer operation time, peripheral vascular disease and direct oral anticoagulants were independently associated with any leg wound infection at the harvest site. Among surgically revised patients, female sex and insulin or oral treatment for diabetes mellitus as well as longer operation time were independent risk factors. Smoking was not associated with leg wound infection.

CONCLUSION: Female sex is associated with increased risk of leg wound infection. The underlying mechanism is unknown. In the current population, previous or current smoking was not associated with an increased risk of leg wound infection.

Introduction

Coronary artery bypass grafting (CABG) is the most common cardiac surgery throughout the world. The most commonly used graft is the saphenous vein. Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2% to 20%. Surgical site infection can be long-lasting, and the wound healing can be difficult and also presumably troublesome for the patient. CABG patients’ experiences of severe infection in the harvesting site have not been studied before.Aim: The aim of this study was to describe patients’ experiences associated with acquiring a severe infection in the harvesting site after CABG.

Method A qualitative study with descriptive design was conducted at the department of vascular and cardiothoracic surgery in a Swedish university hospital from May to December 2018. Patients diagnosed with a severe surgical site infection in the harvesting site following CABG were included. Data from 16 face-to-face interviews were analysed with inductive qualitative content analysis.

Result The main category, varying impact on body and mind, was the core of the patients’ experiences of severe wound infection in the harvesting site after CABG. Two generic categories were identified: physical impact and thoughts about the complication. The patients described experiencing different degrees of pain, anxiety, and limitation in daily life.

Conclusion These findings indicate that a severe infection in the harvesting site after CABG was experienced as an important issue with varying impact. Overall, the participants experienced pain, anxiety, and limitations in daily life. However, most of them were satisfied with the outcome after the wound had healed. Patients should be advised to seek care at an early stage if symptoms of infection occur. Improved individual pain management is needed for those with severe pain, and varied experiences imply a need for person-centred care.