A Scoping Review
KEY FINDINGS: Nurses recognise the value of objective measures in determining the risk of pressure injury and are the primary end-users of point-of-care subepidermal moisture devices. However, standardising procedural instructions and interpretive criteria to guide preventative measures requires further research. International pressure injury clinical practice guidelines advocate for subepidermal moisture devices as an adjunct to routine clinical skin assessment, although little is known about bedside use. This scoping review reveals low adoption of such devices and the need to develop standardised procedures in their use and interpretation.
BACKGROUND: Purpose of the study is to map current literature on bedside clinicians' use of point-of-care subepidermal moisture devices to identify increased pressure injury risk. Pressure injuries are a substantial healthcare burden. Localised oedema occurs before visible or palpable changes, and therefore is a biomarker of increased pressure injury risk. Novel bedside technologies that detect localised oedema may aid early pressure injury preventative practices.
DETAILS: Arksey and O'Malley's six-step framework and the PRISMA-ScR guidelines guided this scoping review. CINAHL Complete, Embase, SCOPUS, Cochrane (wounds) and PubMed databases were searched for primary research and quality improvement projects published in English between 2008–2022. Included studies focused on clinicians' bedside use of subepidermal moisture devices to quantify localised oedema and pressure injury risk. The PAGER framework supported narrative synthesis of the extracted data. Nine studies were selected from 1676 sources. Two point-of-care subepidermal moisture devices were identified in clinical use, largely by nurses. Inconsistent use and interpretations revealed significant knowledge gaps in clinical practice. Additionally, no included studies engaged patients or the public in their design.
Copyright © John Wiley & Sons Ltd. All rights reserved.
Source: McLaren-Kennedy, A., Chaboyer, W., Carlini, J., et al. (2023). Use of Point-of-Care Subepidermal Moisture Devices To Detect Localised Oedema and Evaluate Pressure Injury Risk: A Scoping Review. J Clin Nurs. 2023; 32(17-18): 5478-5492. Published: September, 2023. DOI: 10.1111/jocn.16630.
A Non-A Priori Analysis.
KEY FINDINGS: Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO2 as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.
BACKGROUND: Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. Objective of this study is to describe changes in continuous kidney oxygenation (RrSO2) measures before, during, and after routine diaper changes.
DETAILS: Method used: Non–a priori analysis of a prospective cohort that received continuous measurement of RrSO2 with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO2 drops surrounding diaper changes. In total, 26 of 38 (68%) infants (<=1800 g) from our cohort exhibited acute drops in RrSO2 that temporally correlated with diaper changes. Mean (SD) RrSO2 baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change (P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery (P < .001; 95% CI, -16.9 to -11.2). The mean decrease in RrSO2 during diaper change averaged 12 points (17%) below 15-minute RrSO2 mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO2, blood pressure, or heart rate were documented during the intermittent kidney hypoxic events.
Copyright © The National Association of Neonatal Nurses. All rights reserved.
Source: Marin, T., Ghosh, S., Cockfield, C., et al. (2023). Routine Diaper Change Alters Kidney Oxygenation in Premature Infants: A Non-A Priori Analysis. Advances in Neonatal Care. 2023; 23(5): 450-456. Published: October, 2023. DOI: 10.1097/ANC.0000000000001082.
Comparisons Among People Aging With and Without HIV.
KEY FINDINGS: AD screening rates after incident HF remain suboptimal but increased over time and were higher in PWH. Future quality improvement and implementation efforts should aim for universal AD screening with incident HF diagnosis, initiated by providers skilled in discussing AD, including in the cardiology subspecialty setting.
BACKGROUND: Heart failure (HF) is common among people aging with HIV (PWH) and without HIV (PWoH). Despite the poor prognosis for HF, advance directives (AD) completion is low but has not been compared among PWH and PWoH. Study was performed to determine the prevalence and predictors of AD screening among PWH and PWoH with incident HF.
DETAILS: Veterans with an incident HF diagnosis code from 2013–2018 in the Veterans Aging Cohort Study (VACS) without prior AD screening were included in the study. Health records were reviewed for AD screening note titles within -30 days to 1-year post-HF diagnosis. Analyses were stratified by HIV status. Trends in annual AD screening were evaluated with the Cochran-Mantel-Haenszel test. The associations of AD screening with demographics, disease severity (Charlson Comorbidity Index, VACS 2.0 Index), and healthcare encounters (cardiology, palliative care, hospitalization) were evaluated with Cox proportional hazards regression. HF was diagnosed in 4516 Veterans (28.2% PWH, 71.8% PWoH). Annual AD screening rates increased in both groups (Ptrend<0.0001) and aggregate rates were higher among PWH than PWoH (53.5% vs. 48.2%, p=.001). In both groups, the likelihood of AD screening increased with greater disease severity, palliative care contact, and hospitalization (HR range=1.04–3.32, all p<=.02) but not with cardiology contact (p>=.53).
Copyright © Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Source: Walenczyk, K. M., Cavanagh, C. E., Skanderson, M., et al. (2023). Advance Directive Screening Among Veterans With Incident Heart Failure: Comparisons Among People Aging With and Without HIV. Heart & Lung: Heart & Lung: The Journal of Cardiopulmonary and Acute Care. 2023; 61: 1-7. Published: September, 2023. DOI: 10.1016/j.hrtlng.2023.03.018.
KEY FINDINGS: The Portuguese version of the Infant Positioning Assessment Tool, with five items, proved to be a sensitive, valid, and reliable instrument for observing positioning of newborns, which is why its use in neonatal units is suggested.
BACKGROUND: Objective of this study is to cross-cultural adaptation and validation of the Infant Positioning Assessment Tool for Portuguese Preterm Neonates. Therapeutic positioning provides postural support, with immediate and long-lasting impacts on development. Some studies have suggested the importance of applying positioning-related instruments.
DETAILS: A scoping review identified the Infant Positioning Assessment Tool, which was used in a methodological and cross-cultural study. Its psychometric validation was performed in a nonprobability preterm neonates sample (n = 90). Internal consistency and item sensitivity were assessed by using Cronbach's alpha coefficient and asymmetry and kurtosis coefficients, respectively. The following empirical indices were used to assess convergent validity (CV): chi-square over degrees of freedom (df), a goodness-of-fit index (GFI), a normed-fit index (NFI), an incremental-fit index (IFI) and root mean square error of approximation (RMSEA), an average extracted variance index, and composite reliability (CR). Confirmatory factor analysis of the factorial model showed an insufficient goodness-of-fit adjustment for the first model, with six items. One item was removed, and the resulting second model was adjusted to five items and showed more acceptable results (X2(9) = 52.70; p 0.001; X2/df = 5.85; n = 90; GFI = 0.86; NFI = 0.64; IFI = 0,68; CFI = 0,67; RMSEA = 0.234); CR = 0.74 and CV = 0.50.
Copyright © Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Source: Cruz, I. R., Santos Curado, M. A., Goncalves Brante, A. L. (2023). Infant Positioning Assessment Tool: Transcultural adaptation and validation for Portuguese Preterm Neonates. J. Neonatal Nurs.. 2023; 29(4): 669-674. Published: August, 2023. DOI: 10.1016/j.jnn.2023.01.003.
KEY FINDINGS: Results may be helpful for hospitals striving to optimize care for infants exposed to opioids, using assessments of eating, sleeping, and consoling to guide individualized treatment decisions and to reduce morphine use.
BACKGROUND: A nurse led a team of providers in a quality improvement (QI) project to positively impact inpatient care and outcomes for infants with neonatal abstinence syndrome (NAS). The Eat Sleep Console (ESC) model was implemented to promote rooming-in and family-centered care as part of a nonpharmacological treatment approach.
DETAILS: Objective of the study is to compare the ESC model with the traditional Finnegan treatment approach to describe differences in infants' pharmacotherapy use (morphine), length of stay (LOS), weight loss, consumption of mother's own milk by any feeding method within 24 hours of discharge, Neonatal Intensive Care Unit (NICU) use, and Pediatric Unit utilization. The QI project was conducted at a single hospital site with more than 1700 deliveries per year in the Midwestern United States. A comparative effectiveness study design was used to evaluate the ESC model. The ESC model impacted care and outcomes for infants with NAS, contributing to a significant reduction in morphine treatment, decrease in LOS among morphine-treated infants, increase in weight loss in infants who did not require morphine treatment, less NICU use, and greater Pediatric Unit utilization. A nonsignificant increase was found in the number of infants who consumed their mother's own milk by any feeding method in the 24-hour period prior to discharge.
Copyright © The National Association of Neonatal Nurses. All rights reserved.
Source: Haaland, G., Kunkel, M., Nguyen, C. M., et al. (2023). Using the Eat Sleep Console Model to Promote Optimal Care and Outcomes for Infants With Neonatal Abstinence Syndrome: A Nurse-Driven, Multidisciplinary Initiative. Advances in Neonatal Care. 20203; 23(4): 320-329. Published: August, 2023. DOI: 10.1097/ANC.0000000000001028.