Pressure ulcer point prevalence, classification, locations, and preventive measures: Insights from a Norwegian nursing home survey.

OBJECTIVE: To report data from a point pressure ulcer (PU) prevalence survey on prevalence, PU categories, locations and preventive interventions at one Norwegian nursing home. METHODS: A cross-sectional research design was used. One nursing home in Norway participated in the prevalence survey in 2020. The data were collected on one selected day. A total of 74 out of 88 residents (84.1%) participated. Descriptive statistical analyses were run. RESULTS: The overall prevalence of PUs was 27% amongst all participants in the nursing home, who together had a total of 57 PUs categorised as category I-III. One major finding was that the most common site of the PUs was on the residents' toes. Interestingly, the prevalence of PUs in the residents' sacrum was considerably low. The most frequently used PU preventive interventions were foam chair cushions, nutritional supplements and pressure-reducing heel protection. CONCLUSION: This study identified a high prevalence of PUs, predominantly on residents' toes. Although preventive strategies were implemented, their application appeared limited. Implementing obligatory care packages and annual nationwide PU surveys might be worth considering in municipalities.

Nursing students' attitudes towards the use of digital technology in the healthcare of older adults- a cross-sectional study in Norway and Sweden.

BACKGROUND: Implementation of digital technology has been suggested as a potential solution to future healthcare challenges. Healthcare personnel's attitudes are important in the acceptance and implementation of digital technologies. AIM: The aims of this study were to (1) translate and validate two different questionnaires to Norwegian and Swedish respectively, and then (2) use these to examine nursing students' attitudes towards digital technology in healthcare, as well as their attitudes towards older adults' abilities to use digital technology. DESIGN: Cross-sectional. METHODS: A web-based questionnaire was distributed in first year nursing students in a Norwegian and a Swedish university college, respectively. The questionnaire consisted of the short form of the 'Information Technology Attitude Scales for Health (ITASH)' and the 'Attitudes Towards Older Adults Using Digital technology (ATOAUT-11)' questionnaire. The questionnaires were translated and validated in both countries. Frequencies, Student's t-test, and one-way ANOVA were used to analyze the data. RESULTS: In total 236 students responded to the questionnaire in the period September 2022 to April 2023. Students mainly reported positive attitudes towards digital technology use in general. They most agreed with the items 'Using digital technology devices makes my communication with other health professionals faster', 'The sort of information I can get from the digital technology devices helps me give better care to patient', and 'Digital technology skills are becoming more and more necessary for healthcare professionals'. However, they reported more negative attitudes towards older adults using digital technology. They most agreed with the items 'One needs a lot of patience to explain to an older adult how to use digital technologies', 'It's hard to explain to older adults how to use digital technology', 'Using digital technology is harder for most older adults', and 'Most older adults fear using digital technology because they fear of being scammed or cheated'. CONCLUSION: The ITASH and the ATOAUT-11 is appropriate for use in a Norwegian and Swedish setting. Even if nursing students are positive to digital technology in healthcare in general, they are sceptical to older adults using digital technology. This may impact on their attitudes to using digital technology in the healthcare of older adults. These aspects need emphasis when revising nursing education curricula focusing on developing technological competencies in nursing, and gaining knowledge regarding older adults' use of digital technology.

Health Care Personnel's Perspectives on Quality of Palliative Care During the COVID-19 Pandemic - A Cross-Sectional Study.

Purpose: The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic. Methods: This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents' demographics and quality of care, the latter measured by the short form of the Quality from the Patient's Perspective-Palliative Care instrument, adapted for HCP. The STROBE checklist was used. Results: This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement. Conclusion: Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.

A new compression stocking with well-defined pressure-a randomized controlled pilot study.

BACKGROUND: To evaluate an innovative class I compression stocking with predetermined uniform pressure in comparison to a graduated class III compression stocking system, regarding edema reduction, interface pressure, and patient comfort. METHOD: Twenty-five patients with chronic venous disease, were randomized: 12 to investigational stocking, 13 to comparator stocking. Data collected at baseline and after 14 days. RESULTS: Edema was significantly equal reduced to follow-up; mean -129.0 cm3 (SD 105; p = .004, Class I) and -223.7 cm3 (SD 120; p = .002, Class III), respectively. The investigational stocking lost significantly less compression pressure than the comparator stocking (p ≤ .013). Participants in both groups perceived significant improvement regarding leg heaviness, leg swelling, and feelings of tightness and tingling (p ≤ .016). CONCLUSION: The innovative investigational class I stocking appears to offer similar edema reduction and benefits to the comparator class III stocking. However, a larger and prolonged study is required. The study was registered in the ISRCTN-registry, ISRCTN17356077, https://www.isrctn.com/ISRCTN17356077.

What are the prognostic factors for the development of incontinence-associated dermatitis (IAD): a protocol for a systematic review and meta-analysis.

INTRODUCTION: Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research. METHODS AND ANALYSIS: This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance. ETHICS AND DISSEMINATION: No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.

Missed nursing care in emergency departments: A scoping review.

BACKGROUND: Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts. AIM: The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs. METHOD: A scoping review following the framework suggested by Arksey and O'Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation. RESULTS: In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe. CONCLUSION: The findings from this scoping review indicate that patients' fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.

Person-Centeredness in Digital Primary Healthcare Services-A Scoping Review.

Background: Transformation toward digital services offers unique opportunities to meet the challenges of responding to changing public healthcare needs and health workforce shortages. There is a knowledge gap regarding digital health and person or patient-centered care. Aim: The aim of the current scoping review was to obtain an overview of existing research on person or patient centeredness in digital primary healthcare services. Design: A scoping review following the five stages by Arksey and O'Malley. Methods: Literature searches were conducted in the databases PubMed, Scopus (Elsevier), APA PsychInfo (Ovid), Embase (Ovid), Cinahl (Ovid) and Cochrane Library in June 2022. The Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. Results: The electronic database searches identified 782 references. A total of 116 references were assessed in full text against the inclusion and exclusion criteria. Finally, a total of 12 references were included. The included papers represent research from 2015 to 2021 and were conducted in eight different countries, within a variety of populations, settings and digital solutions. Four themes providing knowledge about current research on patient or person centeredness and digital primary health care were identified: 'Accessibility', 'Self-management', 'Digitalization at odds with patient centeredness' and 'Situation awareness'. The review underlines the need for further research on these issues.

Validation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care, a Swedish version.

AIM: The aim of the study was to translate, adapt and validate the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care for use in the Swedish community health care context. DESIGN: A cross-sectional study. Data were collected from October 2019 to January 2020, and the questionnaire was sent to Registered Nurses, Enrolled Nurses and assistant nurses. METHODS: The study was performed in four phases: (1) translation, (2) adaptation of the Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care to the Swedish context, (3) content validity testing, and (4) evaluation of psychometric properties. The collected data resulted in 611 responses. Explorative factor analysis was performed to explore the interrelationship, and Cronbach's alpha was used to evaluate the internal consistency. RESULTS: Explorative factor analysis presented six factors/subscales: (1) fundamental care, (2) timely needed-based care, (3) dignity and support, (4) ensuring respectful treatment, (5) social activities, and (6) documentation, planning and reporting. The Cronbach's alpha for the components showed values between 0.7 and 0.9. CONCLUSION: The analyses indicate an instrument to be usable for Enrolled Nurses and nurse assistants in community health care. Additional tests, can contribute to refining the content of the items and further test reliability and validity of the instrument. NO PATIENT OR PUBLIC CONTRIBUTION: As this is a study of translation and validation of the instrument Basel Extent of Rationing of Nursing Care for Nursing Homes and Home Care.

The Use of Robotic Technology in the Healthcare of People above the Age of 65-A Systematic Review.

AIM: The integration of robots can help provide solutions in regards to the need for an increase in resources in healthcare. The aim of this review was to identify how robots are utilized in the healthcare of people who are over the age of 65 and how this population experiences interacting with healthcare robots. DESIGN: A systematic literature review with an integrated design was conducted. METHODS: A literature search was performed in the electronic databases CINAHL via EBSCO, EMBASE, and Medline via Ovid. Content analysis was performed to assess the studies that were included in this review. RESULTS: A total of 14 articles were included. Participants in the studies included 453 older people ranging from 65 to 108 years of age. Nine of the studies focused on people with dementia or cognitive impairment. Seven studies included different types of socially assistive human-like robots, six of the studies included two different types of animal-like robots, and one study focused on a robotic rollator. The robots mainly served as social assistive- or engagement robots.

Using pressure mapping intraoperatively to prevent pressure ulcers-A quasi-experimental study.

Background and Aim: Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods: A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results: The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion: Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room.

The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument.

Informal caregivers and assistive technology in Norwegian nursing homes.

AIM: To explore informal caregivers' experiences and perspectives concerning assistive technology (AT) in two nursing homes, through the conceptual lens of person-centredness. BACKGROUND: The integration and use of AT and a person-centred approach to care are political intentions within healthcare services, both internationally and in Norway. In nursing homes, informal caregivers are often collaborators with the staff, and can be important partners concerning the implementation of AT in a person-centred way. However, there is little knowledge about the informal caregivers' perspectives on the use of AT in nursing homes, or of whether or how they are included in the integration and use of AT. METHODS: The study had a qualitative design and comprised eleven informal caregivers of residents in two nursing homes in Norway. In-depth interviews were used for data collection. The data were analysed using content analysis. COREQ reporting guidelines were applied to ensure comprehensive reporting. RESULTS: Emerging themes highlighted the slow-going transition from old to new technology, and how the informal caregivers experienced that AT both promoted and degraded the dignity of their family members. Informal caregivers were positive to the use of technology, but have sparse knowledge and information about ATs in the nursing homes. They express a desire for AT to increase activity and safety, which promotes dignity, quality of life, and quality of the care for their family member. The informal caregivers want their family member to be seen, heard, and to get assistance on their own terms, even with regard to technology. CONCLUSION: Before AT can be implemented, informal caregivers need to be informed and listened to and included in the processes. Through their stories, one can form an idea of how important a person-centred approach is to contributing to individually tailored and introduced AT in collaboration with the informal caregivers.

Healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care: a cross-sectional study.

BACKGROUND: In complex healthcare organizations, such as intrapartum care, both patient safety culture and teamwork are important aspects of patient safety. Patient safety culture is important for the values and norms shared by interprofessional teams in an organization, and such values are principles that guide team members' behavior. The aim of this study was 1) to investigate differences in perceptions of patient safety culture and teamwork between professions (midwives, physicians, nursing assistants) and between labor wards in intrapartum care and 2) to explore the potential associations between teamwork and overall perceptions of patient safety and frequency of events reported.  METHODS: The design was cross-sectional, using the Swedish version of the Hospital Survey on Patient Safety Culture (14 dimensions) and the TeamSTEPPS® Teamwork Perceptions Questionnaire (5 dimensions). Midwives, physicians, and nursing assistants in three labor wards in Sweden in 2018 were included. Descriptive statistics, the Kruskal-Wallis H test, two-way ANOVA, and standard multiple regression analysis were used. RESULTS: The questionnaires were completed by 184 of the 365 healthcare professionals, giving a response rate of 50.4%. Two-way ANOVA showed a significant main effect of profession on two patient safety culture dimensions and one teamwork dimension and a significant main effect of labor ward on four patient safety culture dimensions and four teamwork dimensions. A significant interaction effect of profession and labor ward was found on four patient safety culture dimensions and four teamwork dimensions. The regression analysis revealed that four out of the five teamwork dimensions explained 40% of the variance in the outcome dimension ´Overall perceptions of patient safety´. CONCLUSIONS: The results of the study indicate that profession and labor ward are important for healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care. Teamwork perceptions are significant for overall patient safety.

Prevalence, type, and reasons for missed nursing care in municipality health care in Sweden - A cross sectional study.

BACKGROUND: With an ageing population, there is an increasing need for care, both as home care and in nursing homes. However, some needed care is not carried out for different reasons, which can affect patient safety. The aim of the study was to describe prevalence, type, and reasons for missed nursing care in home care and nursing homes, from nurses' perspective. METHODS: A cross sectional design with quantitative and qualitative approach. A Swedish version of Basel Extent of Rationing of Nursing Care for nursing homes and 15 study specific questions were answered by 624 registered nurses, enrolled nurses, or nurse assistants. Both descriptive and analytical, independent-samples t-test, analyses were used. Qualitative content analysis was used for the open-ended question. RESULTS: The care activity most often missed in home care was: 'set up or update care plans' (41.8%), and in nursing homes: 'scheduled group activity' (22.8%). Reasons for missed nursing care were lack of preparedness for unexpected situations, obstacles in a deficient work environment, unsatisfactory planning in the organisation, and/or shortcomings related to the individual. CONCLUSION: Not all care activities needed are performed, due to reasons such as lack of time or organisational issues. Missed nursing care can lead to adverse events and affect patient safety. It is important to be aware of missed nursing care and the reasons for it, which gives a possibility to initiate quality improvement work to ensure patient safety.

Pressure ulcer prevalence and prevention interventions - A ten-year nationwide survey in Sweden.

The aim of this study was to describe pressure ulcer prevalence and prevention interventions in hospital care in Sweden based on nationwide surveys conducted over a 10-year period. All Swedish hospitals were invited to participate in annual pressure ulcer prevalence surveys during the period 2011-2020. The data collection protocols included gender, age, skin assessment, risk assessment, and preventive interventions. In total, more than 130,000 patients were included in the ten prevalence surveys. The prevalence of pressure ulcers in Swedish hospital patients decreased significantly from 17.0 %to 11.4% between 2011 and 2020 and hospital-acquired pressure ulcers decreased from 8.1% to 6.4% between 2018 and 2020. There was no significant decline in medicaldevice-related pressure ulcers during the same period. The proportion of patients who were risk and skin assessed increased, as did the use of pressure-reducing mattresses, sliding sheets, heel protection, and nrepositioning plans. This study shows that the implementation of a national patient safety program has had an impact on the nationwide prevalence of pressure ulcers in hospital care and the occurrence of prevention strategies. However, one in ten patients in Swedish hospitals still suffers from pressure ulcers. Further improvements can be made.

The Swedish version of the attitude towards pressure ulcer prevention instrument for use in an operating room context (APUP-OR): A nationwide psychometric evaluation.

INTRODUCTION: To assess operating room (OR) nurses' attitudes towards pressure ulcer prevention, the Attitude towards Pressure Ulcer Prevention (APuP) instrument was developed. AIM: The aim of this study was to psychometrically evaluate the Attitude towards Pressure Ulcer Prevention (APuP) instrument in a Swedish OR context. MATERIALS AND METHODS: A psychometric evaluation study was conducted, using a convenience sample, between February and August 2020. Validity (content, construct, discriminatory power) and reliability (stability and internal consistency) were evaluated. RESULTS: The first survey (test) was completed by 284 Swedish OR nurses, of whom n = 50 (17.6%) completed the second survey (retest). A Principal Component Analysis was conducted for the 13-item instrument. The KMO value for this model was 0.62. Bartlett's test for sphericity was statistically significant (p 0.001). Five factors were identified which accounted for 56% of the variance in responses related to attitudes toward pressure ulcer prevention. The Cronbach's α for the instrument "attitude towards Pressure Ulcer Prevention" was 0.66. The intraclass correlation coefficient was 0.49 (95% CI = 0.25-0.67). CONCLUSION: This Swedish version of the APuP- OR is the first step in the development of an instrument to measure OR nurses' attitudes towards PU prevention in a Swedish OR context. The reliability of the instrument was low and the validity moderate. A larger sample and the revision or addition of items related to the context of the operating room should be considered in order to confirm aspects of the psychometric properties.

A scoping review-Missed nursing care in community healthcare contexts and how it is measured.

AIM: To examine the extent and nature of missed nursing care in elderly care in community healthcare contexts from the perspective of healthcare staff, and to identify instruments used to measure missed nursing care and the content of these instruments. DESIGN: Scoping review. METHODS: Searches were conducted in the CINAHL, PubMed, Scopus and Google Scholar databases in March 2020. The selection process followed the PRISMA flow diagram. RESULTS: Sixteen research papers were found from nine countries. The instruments used in the studies were Basel Extent of Rationing of Nursing Care for nursing homes (BERNCA-NH), modified MISSCARE survey and study-specific instruments or items. The item content differed, as did the number of items, which was between one and 44. The studies reported values for missed nursing care, as well as described reasons for and/or the relation between missed nursing care and organization, working climate and patient outcomes.

Adverse events in women giving birth in a labor ward: a retrospective record review study.

BACKGROUND: Childbirth could negatively affect the woman's health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward. METHODS: The study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson's Chi-square test and Student's t-test were used. RESULTS: A total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of 'prolonged hospital care' (63.2%) and 'temporary harm' (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable. CONCLUSIONS: This first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3rd-or 4th-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

The Swedish version of the TeamSTEPPS® teamwork attitudes questionnaire (T-TAQ): A validation study.

BACKGROUND: Effective teamwork is essential for delivering safe health care. It is important to increase patient safety in healthcare by conducting interprofessional team training with both healthcare professionals and undergraduate students. Validated questionnaires that evaluate team training activities contribute to valuable knowledge regarding changes in attitudes toward teamwork. The aim of the study was to test the reliability and structural validity of the Swedish version of the TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ). METHODS: The study had a cross-sectional design. Four hospitals in three health care regions in Sweden participated in the study. In total, 458 healthcare professionals, response rate 39.4%, completed the questionnaire. The T-TAQ, which consists of 30 items and covers five dimensions (Team Structure, Leadership, Situation Monitoring, Mutual Support and Communication), was translated to Swedish. A paper version of the T-TAQ was distributed to healthcare professionals (physicians, registered nurses, midwives, nursing assistants and allied health professionals) from the hospitals. Reliability and validity were tested using Cronbach's alpha and confirmatory factor analysis. RESULTS: Cronbach's alpha was 0.70 for the total T-TAQ and ranged from 0.41 to 0.87 for the individual dimensions. The goodness-of-fit indexes in the confirmatory factor analysis (Model 2) revealed a normed chi-square of 2.96, a root mean square error of approximation of 0.068, a Tucker-Lewis index of 0.785 and a comparative fit index of 0.808. CONCLUSIONS: The Swedish version of the T-TAQ has some potential to measure healthcare professionals' general attitudes toward the core components of teamwork in hospital settings. Further validation studies of the Swedish version of the T-TAQ are required, with samples representing both healthcare professionals and students from various healthcare disciplines and educational levels.

Development and psychometric property testing of a skin tear knowledge assessment instrument (OASES) in 37 countries.

AIM: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). DESIGN: Prospective psychometric instrument validation study. METHOD: The skin tear knowledge assessment instrument was developed based on a literature review and expert input (N = 19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April-May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test-retest reliability (stability) were analysed and evaluated in light of international reference standards. RESULTS: A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI = 0.90-1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01-0.52. The discriminating index was acceptable (0.19-0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p < .001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.78-0.86) for the full instrument and varied between 0.72 (95% CI = 0.64-0.79) and 0.85 (95% CI = 0.81-0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. CONCLUSION: The skin tear knowledge assessment instrument is supported by acceptable psychometric properties and can be applied in nursing education, research, and practice to assess knowledge of healthcare professionals about skin tears. IMPACT: Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice, and research needs and priorities related to skin tears in clinical practice.