Visibility of inflicted bruises by alternate light: Results of a randomized controlled trial.

Difficulty visualizing bruises resulting from interpersonal violence, especially in individuals with dark skin, contributes to disparities in access to justice. The purpose of this analysis was to compare bruise visibility of detected injuries using white light versus alternate light sources (ALS). Visibility was assessed using the 5-point Bruise Visibility Scale (BVS) for white light and the ALS Visibility Scale (AVS) for ALS. Bruises were induced using controlled application of a paintball to the upper arm on 157 healthy adults across six skin color categories. Using a crossover design, the light source used first to assess the bruise (white light or ALS) was randomized. Each bruise was examined up to 21 times over 4 weeks using white light and 10 combinations of wavelengths (350 nanometer [nm] - 535 nm) and colored filters (yellow, orange, and red). Multilevel modeling was used to analyze the repeated measures data with a total 20,103 bruise assessments. Results revealed 415 nm with yellow filter resulted in an almost 0.5-point increase in BVS/AVS score across all skin colors (Estimate = 0.46; 95% CI: 0.43, 0.49; p < 0.001), a clinically significant improvement in ability to visualize bruises. Conversely, 515 nm (Estimate = -0.80; 95% CI: -0.84, -0.76; p < 0.001) and 535 nm (Estimate = -0.64, 95% CI: -0.67, -0.60; p < 0.001) with red filter resulted in more than 0.5-point decrease in BVS/AVS score. The use of ALS is supported by the data and results in improved bruise visibility during medical forensic examinations.

Systematic review: Self-efficacy and skill performance.

AIM: The aim of this systematic review was to investigate the relationship between self-efficacy and skill performance in undergraduate student nurses. BACKGROUND: Across higher education, self-efficacy is an important predictor of student success in skill-based learning. Nursing students are required to demonstrate skills prior to caring for hospitalized patients. Understanding the relationship between self-efficacy and nursing student skill performance may support patient safety. METHODS: Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic search was conducted of four databases: CINAHL, Medline, Psychinfo, and Web of Science. Quantitative, peer-reviewed studies published in English were included with no limitation on year. Hands-on skill performance had to be performed in laboratory or simulation settings and evaluated by an expert. Identified studies were assessed for methodological rigor using Joanna Briggs Institute's Critical Appraisal Tools. FINDINGS: A total of 2,450 items were identified by database search and screened, resulting in 20 eligible studies. Most of the studies included novice first- or second-year students. Self-efficacy was operationalized as either a general or skill-specific measure, while the type of skill and associated instrumentation varied widely. Sixteen (80%) of the included study reports showed weak to no correlation between self-efficacy and skill performance. The remaining 4 reports noted a moderate-to-strong relationship. CONCLUSION: Our findings conflict with existing research in other higher education disciplines where self-efficacy is a significant predictor of performance success. Explanations for this contradiction likely center around how self-efficacy was operationalized and rigor of the included studies. IMPLICATIONS FOR NURSING: Larger studies controlling for confounding variables are needed to understand this relationship with a goal of developing more consistent approaches to teaching and learning skills within prelicensure curriculums.

Interventions to Enhance Nursing Student Compliance With Infection Control: A Systematic Review.

AIM: The purpose of this review was to identify effective strategies for improving infection control practices among prelicensure nursing students. BACKGROUND: Infection control practices are fundamental skills taught to prelicensure nursing students. The most effective teaching strategy to support infection control behaviors has yet to be determined. METHOD: A systematic search of peer-reviewed English literature published before October 2021 was conducted in three databases, followed by critical appraisal. Outcomes included either observed or self-reported infection control behaviors. RESULTS: Twelve eligible studies met inclusion criteria for qualitative synthesis. Studies with integrated simulation or multimodal interventions generally achieved higher infection control compliance than those with greater emphasis on traditional education. The appraisal noted intervention/instrument heterogeneity and limited control. CONCLUSION: Didactic infection control education should be supplemented with other modalities, but further controlled studies are needed to identify which specific approach is most effective.

"It Takes a Village" to Implement Family-Centered Care in the Neonatal Intensive Care Unit.

BACKGROUND: Although research has demonstrated positive impacts of family-centered care (FCC), many neonatal intensive care unit (NICU) nurses hesitate to fully engage in its practice. There has been little scientific focus on investigating the challenges of FCC implementation in the NICU setting. PURPOSE: The purpose of this study was to generate a grounded theory explaining the process by which neonatal nurses experience facilitators and challenges through engaging in FCC practices in the context of the NICU setting. METHODS: This qualitative, grounded theory portion of a mixed-methods study employed individual, semistructured, video-based dyadic interviews with 20 neonatal nurses. RESULTS: Successful implementation of FCC by neonatal nurses is affected by various factors. The adage that "it takes a village to raise a child" described this process for the nurse participants. The delivery of FCC involves respectful engagement and participation by multiple internal and external stakeholders. The process of delivering FCC was influenced by factors across 6 categories: equitable relationships, bond of trust, knowledge sharing, empowerment in workplace, environment and culture, and regulations. The findings suggest that FCC implementation is not an individual initiative; rather, it involves a complex set of interrelationships between care team members. NICU nurses may consider these findings when they are proposing a change to a FCC model. IMPLICATIONS FOR PRACTICE AND RESEARCH: Flexibility is necessary by multidisciplinary teams to achieve maximum benefits of FCC and minimize potential harm, despite the unit design. Facilities may support nurses with continuing education programs to expand their FCC knowledge and skills.

Improving the Forensic Documentation of Injuries Through Alternate Light: A Researcher-Practitioner Partnership.

ABSTRACT: An alternate light source (ALS) is a practitioner-driven technology that can potentially improve the documentation of injuries among victims of interpersonal violence. However, evidence-based guidelines are needed to incorporate and document an ALS skin assessment into a forensic medical examination that accurately reflects the science, context of forensic nursing practice, trauma-informed responses, and potential impact on criminal justice stakeholders. This article introduces the forensic nursing community to a current translation-into-practice project focused on developing and evaluating an ALS implementation program to improve the assessment and documentation of bruises among adult patients with a history of interpersonal violence. Our researcher-practitioner collaboration uses theory-based approaches that consider both the developed program's practice context and stakeholder impact. The goal is to provide evidentiary support for adult victims of violence and a more equitable forensic nursing practice that benefits diverse patient populations.

Effects of family-centered care on bonding: A systematic review.

Most critically ill neonates require constant monitoring, continuous care, and supervision. However, distance created by admission and prolonged stay in a neonatal intensive care unit (NICU) may contribute to a delay in parent-infant bonding. This review aimed to determine how family-centered care (FCC) in the NICU affects parental bonding with critically ill infants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform a systematic search of the literature within the following four electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science. The search was conducted through July/August 2020. Research quality was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Grading Scale. Out of 816 articles identified through literature search, 16 of the studies met our inclusion criteria. The majority of the studies (n = 14) found FCC interventions resulted in a significant increase in parental bonding. Results showed evidence practicing FCC in the NICU setting supports early parent-infant bonding. Nurses should consider implementing evidence-based FCC strategies into practice, such as allowing parents unrestricted access to their infants. More rigorous research with larger samples is recommended. More studies are also needed focusing on father-infant dyads and mother-father-infant triads.

Predicting alternate light absorption in areas of trauma based on degree of skin pigmentation: Not all wavelengths are equal.

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n = 2777, 11.2%; 450 nm: n = 2747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n = 2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

Factors Related to Concussion Knowledge, Attitudes, and Reporting Behaviors in US High School Athletes: A Systematic Review.

BACKGROUND: Sport-related concussions are a major public health problem with only 50% of concussed teens reporting their symptoms. The purpose of this systematic review was to identify individual and institutional factors that contribute to concussion knowledge, attitude, and reporting behaviors among US high school athletes. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol was used to direct the process of this systematic review. A search for English, peer-reviewed, quantitative studies published between 2010 and 2020 was conducted in 5 scholarly databases. The Joanna Briggs Critical Appraisal Tools were used to assess study quality. RESULTS: Twenty-two studies met criteria for inclusion in this systematic review. The study designs were mostly cross-sectional (N = 18). Synthesis revealed individual factors including gender, age, race/ethnicity, grade level, and concussion history were associated with differences in concussion knowledge, attitude, and/or reporting behaviors. Institutional factors identified included school location, concussion education, access to an athletic trainer, sport played, and team climate. Six studies found concussion education had a positive impact on knowledge and reporting behaviors. CONCLUSION: This systematic review identified certain populations which may be more vulnerable to underreporting concussion symptoms; therefore, a targeted approach to education and management may be more effective.

Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses.

BACKGROUND: Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice. PURPOSE: The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses. METHODS: This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments. RESULTS: Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (ß= 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices ( r =-0.199, P < .001). IMPLICATION FOR RESEARCH AND PRACTICE: Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.

Development and Pilot Analysis of the Bruise Visibility Scale.

The accuracy of assessing and documenting injuries is crucial to facilitate ongoing clinical care and forensic referrals for victims of violence. The purpose of this cross-sectional, pilot study was to evaluate the inter-rater reliability and criterion validity of a newly developed Bruise Visibility Scale (BVS). Methods: The instrument was administered to a diverse sample (n = 30) with existing bruises. Bruises were assessed under fluorescent lighting typical of an examination room by three raters who were randomly selected from a pool of eight experienced clinical nurses. Colorimetry values of the bruise and surrounding tissue were obtained using a spectrophotometer. Results: The BVS demonstrated good single (ICC = 0.71, 95% CI = 0.54 - 0.84) and average agreement (ICC = 0.88, 95% CI = 0.78 - 0.94) between raters. A significant, positive moderate correlation was found between mean BVS scores and overall color difference between the bruise and surrounding skin (Pearson's r = 0.614, p < 0.001). Conclusion: With further research, the BVS has the potential to be a reliable and valid tool for documenting the degree of clarity in bruise appearance.

Multimedia in preoperative patient education for adults undergoing cancer surgery: A systematic review.

PURPOSE: The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients. METHODS: A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design. RESULTS: The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods. CONCLUSIONS: In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.

Quantifying the Degree of Bruise Visibility Observed Under White Light and an Alternate Light Source.

BACKGROUND: Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS). METHODS: Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales. RESULTS: Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values. IMPLICATIONS FOR PRACTICE: Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.

Bedside Technologies to Enhance the Early Detection of Pressure Injuries: A Systematic Review.

BACKGROUND: Hospital-acquired pressure injuries strain organizational resources and negatively impact the quality of life of affected patients. However, early detection of pressure injuries is limited due to challenges with visual assessment, particularly in individuals with dark skin. PURPOSE: The purpose of this systematic review was to determine whether sufficient research evidence exists to support the use of bedside technologies for early detection of pressure injures, which is inclusive of pressure-related blanchable erythema (PrBE), pressure-related nonblanchable erythema (PrNBE), and deep tissue pressure injury (DTPI). SEARCH QUESTION: What available bedside technologies enhance the early detection of pressure injuries? METHODS: A systematic search of Medline, CINAHL, Web of Science, and Cochrane databases was executed. Quantitative studies were included that examined whether accessible technologies could indicate the presence of PrBE, PrNBE, and DTPI. The quality of the research was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. FINDINGS: We identified 18 eligible studies that represented a variety of technologies, including ultrasound (n = 5), thermography (n = 7), subepidermal moisture (SEM) measurement (n = 5), reflectance spectrometry (n = 2), and laser Doppler (n = 1). The methodological rigor in study quality was variable. Subepidermal moisture measurement provided the most consistent findings in the early detection of pressure injury. CONCLUSIONS: Objective methods that provide accurate and timely assessment of DTPIs augment early implementation of optimal prevention and treatment measures. Evidence identified in this systematic review supports the use of SEM measurement devices as effective tools for early pressure injury detection. However, more research in the field of technology-enhanced, pressure injury detection is needed to support the use of existing and emerging devices.

Bruise detection and visibility under alternate light during the first three days post-trauma.

INTRODUCTION: Cutaneous bruises are often hard to detect particularly on individuals with a darker complexion. Researchers and federal agencies have recommended the use of alternate light to aide in the assessment of subtle injury. However, studies are limited in their evaluation of wavelength performance during the first few days of bruise healing. The purpose of this pilot study was to examine whether an alternate light source (ALS) improves detection of bruises when compared to normal light typical of clinical practice during the first three days following induction. METHODS: A sample of eight healthy adults between 22 and 36 years of age with diverse skin color were recruited for this study. One bruise was induced on each participant by dropping a 4-oz (113g) steel ball through a 5-ft (1.5 m) vertical pipe onto the anterior surface of the forearm. Using the ALS, bruises were assessed under 14 different combinations of ultraviolet and short narrowband visible wavelengths and filters along with overhead fluorescent "examination" lighting. Participants were examined 3 to 4 times per day at approximately 4-h intervals for three consecutive days post induction. RESULTS: Repeated bruise assessments on 8 subjects resulted in 59 bruise assessments and 885 total observations under the different wavelengths and filters combinations. A bruise was detectable in 46 (78%) of the assessments, with bruise ages ranging from 30 min to 57 h. Twenty (34%) bruises not detectable under normal light were visible with ASL. Multilevel modeling revealed a strong association between time and detection for shorter wavelengths, such as 365 nm (ultraviolet) and 450 nm. CONCLUSION: The results of our study suggest alternate light is more likely to detect faint bruises than normal lighting during the first three days post injury. However, more research is needed to determine which wavelengths and filter combinations are most effective during that time frame.

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial.

Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350-535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35-6.56; 450 nm: OR = 4.08, 95% CI: 3.36-4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37-3.70; fat: OR = 1.21, 95% CI: 1.09-1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.

Systematic Review of Racial/Ethnic Outcome Disparities in Home Health Care.

INTRODUCTION: Though extensive evidence demonstrates that U.S. minority patients suffer health care disparities, the incidence of disparities among the 3.3 million adult patients receiving skilled intermittent home health care services annually is unclear. The purpose of this systematic review is to determine the relationship of race/ethnicity on home health care patient outcomes. METHODOLOGY: PRISMA guidelines were used to perform a systematic search of the literature within the CINHAL, Medline, and Web of Science databases. Search terms included variations on the terms: home health, minority race/ethnicity, and patient outcomes. Included studies evaluated adult patient outcomes to intermittent skilled home health care services from Medicare-certified agencies using federally defined race/ethnicity categories. Research quality was evaluated using the Johns Hopkins Evidence Based Practice Grading Scale. RESULTS: Seven studies were identified in the search. All studies were of good-to-high quality with the majority having large samples. All seven found a significant difference in patient outcomes related to race/ethnicity. Specifically, minority patients had more adverse events, less improvement in functional outcomes, and worse patient experiences when compared with majority patients. CONCLUSION: Home health care disparities exist and efforts should be made to provide culturally and linguistically appropriate care to all patients.

Alternate Light Source Findings of Common Topical Products.

BACKGROUND: One of the important roles of a forensic clinician is to perform examinations of patients who are victims and suspects of crime. Alternate light source (ALS) is a tool that can improve evidence collection and enhance visualization of injuries. The purpose of this study was to examine if commonly used topical products fluoresce or absorb when examined with an ALS. Second, we aimed to identify patient and examination variables that may impact findings. METHODS: A convenience sample of 81 subjects was used. After the application of 14 over-the-counter products, researchers observed the participants' skin with an ALS under 18 combinations of wavelengths and colored filters. RESULTS: Of the 14 products viewed (n = 1458 observations per product), six were found to fluoresce under alternate light in more than 40% of observations, five fluoresced in 1%-10% of observations, and three fluoresced less than 1% of the time. One product (a makeup product) absorbed ALS light consistently (81%), and a second (a sunscreen product) absorbed in 7%, whereas the remaining 12 products produced absorption findings in less than 1% of observations. In generalized mixed linear models, absorption findings were more commonly identified in participants with light or medium skin tones when compared with those with dark skin tones. DISCUSSION: These results suggest that the presence of topical products may impact ALS findings. A thorough forensic clinical assessment should include a documented history, including assessment of potential sources of findings, to aid in interpretation.

Reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour.

BACKGROUND: Bruising is one of the most common types of injury clinicians observe among victims of violence and other trauma patients. However, research has shown commonly used qualitative description of cutaneous bruise colour via the naked eye is subjective and unreliable. No published work has formally evaluated the reliability of tristimulus colourimetry as an alternative for assessing bruise colour, despite its clinical and research applications in accurately assessing skin colour. The purpose of this study was to systematically evaluate the test-retest and inter-observer reliability of tristimulus colourimetry in the assessment of cutaneous bruise colour. METHODS: Two researchers obtained repeated tristimulus colourimetry measures of cutaneous bruises with participants of diverse skin colour. Measures were obtained using the Minolta CR-400 Chomameter. Commission Internationale d'Eclairage (CIE) L*a*b* colour space was used. Data was analysed using intraclass correlation coefficients (ICC), Cronbach's alpha, and minimal detectable change (MDC) on all three L*a*b* values. RESULTS: The colorimeter demonstrated excellent test-retest or intra-rater reliability (L* ICC=0.999; a* ICC=0.973; b* ICC=0.892) and inter-rater reliability (L* ICC=0.997; a* ICC=0.976; b* ICC=0.982). CONCLUSIONS: With consistent placement, the tristimulus colourimetry is reliable for the objective assessment and documentation of cutaneous bruise colour for purposes of clinical practice and research. Recommendations for use in practice/research are provided.