PROTOCOL PAPER

Evidence- based protocol paper

Evidence- based protocol paper

Introduction

Pressure ulcers are localised areas of tissue breakdown in skin and/or underlying tissues as a result of a sustained mechanical loading (Bouten et al., 2003). The results of the 2002 European prevalence study indicated that pressure ulcers most frequently develop on bony prominences such as the coccyx (28.6%), heels (26.0%) and ischium (10.0%). Pressure ulcer prevalence in European hospitals was 18.1% (Vanderwee et al., 2007a).

Clinical perception

Treatment is expensive in terms of human suffering because pressure ulcers are painful, the treatment is complex and patients may need to be hospitalised for a longer period ([Allman et al., 1999] and [Hopkins et al., 2006]). In a study by Severens et al. (2002) the cost of pressure ulcers was estimated to be 1% of the total health care budget in The Netherlands.

Literature Review

The European prevalence study in 2002 revealed that no more than 10% of the patients at risk received adequate preventive care (Vanderwee et al., 2007a). Adequate prevention is important in pressure ulcer care since pressure ulcers are often avoidable if effective prevention is provided. The aim of prevention is to reduce the duration and/or the amount of pressure and shear, for which a wide range of effective and ineffective equipment and methods is used.

Good care is based on profound knowledge. Lack of knowledge might lead to misconceptions about pressure ulcer prevention. Ajzen and Madden (1986) recognise knowledge as an important predictor of behavior. A valid and reliable instrument is important to assess pressure ulcer prevention knowledge adequately and to tailor pressure ulcer education.

This literature overview focuses on studies describing the development and psychometric validation of instruments to assess the knowledge concerning pressure ulcer prevention. A literature search was performed using the databases PubMed, Embase, The Cochrane Library Central Register of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The keywords 'knowledge', ' pressure ulcer ', 'instrument', 'questionnaire', 'psychometric properties', and 'validation' were combined.

Comparative Evaluation

The electronic databases were searched for studies published in English, Dutch, French and German. There was no limitation concerning year of publication. A similar search filter was used in all databases. The literature search was completed in March 2009. All studies describing the development and validation of a pressure ulcer knowledge instrument and the exploration of pressure ulcer knowledge were included.

The search strategy revealed 384 publications. Seventeen publications described the psychometric evaluation of an instrument to assess knowledge of pressure ulcer prevention.

Pieper and Mott (1995) developed the Pressure Ulcer Knowledge Test. This 47-item true-false knowledge test was based on the clinical practice guideline by the Agency for Health Care Policy and Research (AHCPR). The instrument covered four themes: risk, prevention, classification and wound description.

Content validity was determined by four nurse experts and a pilot testing in 228 nurses was executed. This instrument was used in two other studies ([Pieper and Mattern, 1997] and [Caliri et al., 2003]). Pieper and Mattern (1997) used this instrument to assess critical care nurses' knowledge ...