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: Advances in surgical and anaesthetic techniques have enabled some outpatients to meet the criteria for discharge from the Post-Anaesthetic Care Unit while still in the operating room. These patients may benefit from being transferred directly from the operating room to a dedicated recovery area designed to expedite discharge home-a concept known as fast-tracking. Although this innovative approach to postoperative nursing care has already been implemented in clinical practice, its impact on patient outcomes and patient safety remains uncertain.

OBJECTIVE: This systematic review aims to evaluate the effectiveness of a fast-track pathway compared to the standard recovery pathway after outpatient surgery.

INFORMATION SOURCES: The databases MEDLINE, Embase, Web of Science, CINAHL, Cochrane and Scopus were searched until January 2025.

METHODS: The review included randomised-controlled trials, case-control studies, prospective and retrospective cohort studies that reported on fast-tracking of adult patients undergoing outpatient surgical procedures. Two reviewers independently assessed the eligibility of the articles identified with the search strategy. The risk of bias was assessed with the Risk of Bias 2 tool for randomised-controlled trials and the Risk of Bias in Non-randomised studies of Interventions for non-randomised controlled trials. Due to the heterogeneity of the included studies, a narrative synthesis was conducted to systematically summarise and interpret the findings across studies.

RESULTS: The literature search identified 5226 unique records, with 7 studies of low quality and high risk of bias included in this review. 5 of the 7 studies were published before 2005. Bypass rates varied from 30 % to 87 %. All included studies reported a shorter postoperative length of stay for the fast-track group compared to the standard recovery pathway. The studies indicated that fast-tracked patients had similar, or in some cases, even better outcomes regarding readmission rates and the incidence of postoperative adverse effects compared to the standard recovery pathway.

CONCLUSIONS: Not all patients require admission to the Post-Anaesthetic Care Unit after outpatient surgery. Fast-tracking certain patients may offer benefits, such as a shorter postoperative length of stay, without negatively impacting patient outcomes. By reducing length of stay, improving patient flow and optimising resource utilisation, fast-tracking has the potential to enhance the efficiency and organisation of care while maintaining the quality. However, high-quality studies are needed to evaluate the safety and effectiveness of fast-tracking. As fast-tracking combines the care environments of the Post-Anaesthetic Care Unit and phase II recovery units, tailored nursing care for fast-track patients may be necessary.

REGISTRATION: CRD4202452974, PROSPERO, Registered 23/03/2024.

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.

OBJECTIVE: Numerous studies have examined the epidemiology of skin tears; however, inconsistent definitions, classification systems, and data collection methods have highlighted the need for a validated and standardized tool. The primary objective of this study was to validate a data collection tool for skin tears. A secondary aim was to provide a freely accessible tool for health care providers or researchers to collect consistent and reliable data on skin tears.

METHODS: The development of the tool was guided by the 2018 International Skin Tear Advisory Panel (ISTAP) Best Practice Recommendations for the prevention, assessment, and management of skin tears in aged skin. Between June and October 2024, a multimethod validation process was undertaken. Content validity ratio and content validity index calculations were used to quantify content validity, supported by qualitative feedback from 15 experts to assess face validity and provide suggestions for refinement.

RESULTS: The final tool consists of 22 questions addressing a patient's demographics, clinical features of the skin tear, associated risk factors, and contextual data. The content validity index was calculated at 0.72, indicating an acceptable level of content validity. International experts reached consensus following a 2-round qualitative review, resulting in subsequent adjustments to the tool.

CONCLUSIONS: The ISTAP DC-Tool was developed based on evidence-informed recommendations and validated by an international panel of experts. Its implementation will support health care providers and researchers in gathering standardized epidemiological data contributing to clinical practice improvements, quality initiatives, and further research in skin tear prevention and management.

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.

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.

BACKGROUND & AIMS: In ventilated critically ill patients, both overfeeding and underfeeding can be harmful. Determining energy expenditure is challenging due to various factors. Accurate estimation of nutritional requirements is essential for optimal care. This study compared resting energy expenditure in patients on full-dose high protein-to-energy tube feeding, using indirect calorimetry (IC) and the Roza & Shizgal (R&S) formula. It also examined the effects of sex, age, BMI, primary diagnoses, and non-intentional energy intake, and assessed adherence to European Society for Clinical Nutrition and Metabolism guidelines on protein intake.

METHODS: A retrospective cohort study included 178 ventilated ICU patients who received ≥7 days of full-dose high-protein enteral tube feeding between June 2019 and December 2022. IC was compared to the R&S formula, and 24-hour nutritional intake data, including non-intentional sources, were analysed. Multivariate regression identified predictors of energy expenditure differences.

RESULTS: A significant difference of -146.64 kcal (SD = 276.38) was found between measured and estimated resting energy expenditure, with severe or morbid obesity and COVID-19 pneumonia as significant predictors. This difference increased when non-intentional energy intake in the preceding 24 hours was considered (M = -514.51; SD = 326.37). When excluding non-intentional energy intake, patients achieved the ESPEN daily protein target of ≥1.3 g/kg actual or adjusted body weight/day, with averages of 1.3 to 1.5 g/kg using both indirect calorimetry and the Roza & Shizgal formula.

CONCLUSION: The Roza & Shizgal formula for estimating resting energy expenditure can overestimate or underestimate, so caution is needed, especially in severely to morbidly obese patients. Monitoring energy intake is important, particularly in tube feeding. Protein targets per international guidelines are generally met, except in patients with high non-intentional energy intake.

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.