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Preventing skin tears (STs) in older adults is an urgent public health concern, especially in long-term care (LTC) facilities. However, limited research on ST prevention among care workers exists due to a lack of suitable assessment tools. This study aims to develop and psychometrically evaluate the Knowledge, Attitude and Practice instrument for care workers in preventing Skin Tears (KAP-ST) in older adults.
The KAP-ST was developed and validated in four phases during May–October 2024. First, an item pool was generated through a comprehensive literature review. Second, a preliminary instrument was developed through a Delphi expert consultation and pilot testing. Third, the items and the final instrument were optimised through a cross-sectional survey involving 317 care workers from 29 LTC facilities in China. Finally, a psychometric evaluation was conducted in another cross-sectional survey involving 373 care workers from 18 LTC facilities.
The final KAP-ST contains 35 items across knowledge, attitude and practice dimensions. Exploratory factor analysis (EFA) revealed a nine-factor structure (factor loadings ranging from 0.451 to 0.799, accounting for 61.35% of total variance). The Item-Level Content Validity Index (I-CVI) values ranged from 0.926 to 1.000, and the Scale-Level Content Validity Index (S-CVI/Ave) was 0.991. The instrument's Cronbach's α, split-half, and test–retest reliability coefficients were 0.887, 0.744, and 0.934, respectively. The CFA analysis revealed an ideal absolute fit validity (RMSEA = 0.068; RMR = 0.029) and parsimony fit validity (PGFI = 0.684).
The KAP-ST demonstrates strong reliability, structural validity and content validity. It is well-suited for assessing care workers' knowledge, attitudes and practices in preventing STs among older adults. Further research is required to enhance and confirm its validity.
STs in the spotlight recently necessitate the use of appropriate investigative tools to facilitate in-depth research, especially for care workers, who should prioritise access to specialised knowledge. Introducing professional guidance in LTC facilities is recommended to enhance the knowledge, attitude and practice of care workers.
Standardised Guidelines for Scale Construction and COSMIN checklist.
No patient or public contributions.
This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the ‘structure-process-outcome’ model.
A Delphi survey.
The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.
The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90–5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators.
The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.
This study develops targeted NSQIs to improve dysphagia management in ABI patients’ posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.
Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.
To evaluate and summarize the available evidence on the prevention and management of nasogastric aspiration in critically ill patients to inform the development of evidence-based clinical practice.
This study was an evidence summary according to the evidence summary reporting standard of the Fudan University Center for Evidence-Based Nursing.
According to the ‘6S’ model of evidence resources, evidence on the prevention and management of aspiration in critically ill patients on nasogastric feeding was retrieved, including clinical decision-making, best practices, guidelines, evidence summaries, expert consensus and systematic evaluations.
UpToDate, BMJ Best Practice, JBI, National Guideline Clearing-house, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Yi Mai tong Guidelines Network, the Cochrane Library, PubMed, Web of Science, Embase, OVID, Sinomed, CNKI, Wan Fang database. The search period was from January 2013 to June 2023.
We included a total of 30 high-quality articles and summarized 36 pieces of evidence from them. These pieces of evidence covered 11 dimensions of multidisciplinary management, aspiration risk assessment, tube location, nutritional infusion management, position management, airway management, and oral hygiene. The level of evidence in the study was predominantly level 1 and level 5, with 27 pieces of evidence recommended as ‘strong’ and 9 pieces of evidence recommended as ‘weak’.
This study summarizes 36 pieces of evidence on preventing and managing aspiration in critically ill patients with nasogastric feeding. But the characteristics of hospitals should be considered in the application of future evidence.
Aspiration is the most serious complication during nasogastric feeding, which seriously affects the prognosis of patients. Preventing and managing aspiration in nasogastric patients has proven to be a challenging clinical problem. This study summarized 36 pieces of best evidence in 11 dimensions, including multidisciplinary team, assessment and identification, line position, feeding management, and so on. The implementation of these evidences is conducive to standardizing the operation behaviour of nasogastric feeding in clinical medical staff and reducing the occurrence of aspiration.
This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing.
The registration number is ‘ES20221368’.
This systematic review and meta-analysis evaluate the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve blocks on postoperative wound pain in tibial and foot surgeries, crucial for effective pain management and patient recovery. Adhering to PRISMA guidelines, this study used a PICO framework, focusing on patients undergoing tibial and foot surgeries and comparing the efficacy and safety of subsheath and extrasheath sciatic nerve blocks. The literature search spanned four databases without time restrictions, assessing various outcomes like success rate, onset time, duration of analgesia and complication rates. Quality assessment employed the Cochrane Collaboration's risk of bias tool, and statistical analyses included heterogeneity assessment, fixed-effect and random-effects models, sensitivity analysis and publication bias evaluation using funnel plots and Egger's linear regression test. From an initial pool of 1213 articles, six met the inclusion criteria. The subsheath group showed a significantly higher success rate of complete sensory blockade within 30 min compared with the extrasheath group (OR = 5.39; 95% CI: 2.82–10.28; p < 0.01). No significant differences were found in procedure duration or incidence of nerve-related complications between the two techniques. The subsheath approach also demonstrated a quicker onset time of sensory blockade (MD = −8.57; 95% CI: −11.27 to −5.88; p < 0.01). Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected. Ultrasound-guided subsheath sciatic nerve blocks are more effective than extrasheath blocks in achieving rapid and complete sensory blockade for tibial and foot surgeries, with a quicker onset time and comparable safety profile. Subsheath injections are thus recommended as a preferred method for anaesthesia and postoperative pain management in these surgical procedures, enhancing overall patient outcomes.
Diabetic foot ulcer, is a chronic complication afflicting individuals with diabetes, continue to increase worldwide, immensely burdening society. Programmed cell death, which includes apoptosis, autophagy, ferroptosis, necroptosis and pyroptosis, has been increasingly implicated in the pathogenesis of diabetic foot ulcer. This review is based on an exhaustive examination of the literature on ‘programmed cell death’ and ‘diabetic foot ulcers’ via PubMed. The findings revealed that natural bioactive compounds, noncoding RNAs and certain proteins play crucial roles in the healing of diabetic foot ulcers through various forms of programmed cell death, including apoptosis, autophagy, ferroptosis and pyroptosis.
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