Carina Bååth

Aim: To explore operating room nurses' self‐estimated knowledge and attitudes regarding the prevention of intraoperative pressure ulcers. Background: Pressure ulcers are a significant patient safety concern in surgical settings. Despite being largely preventable, intraoperative pressure ulcers continue to occur due to prolonged immobility, positioning and device‐related pressure. Nurses play a critical role in pressure ulcer prevention, yet knowledge gaps and unclear responsibilities may hinder effective practice. Design: A cross‐sectional study using a quantitative online survey conducted in accordance with STROBE guidelines. Methods: An online self‐reporting survey was distributed to 1904 eligible operating room nurses across Sweden. A total of 284 operating room nurses responded (response rate 15%). The survey included two validated instruments: the Pressure Ulcer Knowledge Assessment Tool—Operating Room (PUKAT 2.0 OR) and the Attitudes toward Pressure Ulcer Prevention—Operating Room (APuP‐OR). Descriptive and non‐parametric statistics were used to analyse the data. Results: Participants displayed solid knowledge of pressure ulcer aetiology, but their understanding of preventive strategies, particularly those related to intraoperative positioning, was markedly weaker. Attitudes towards prevention were consistently positive, and participants generally expressed confidence in their ability to prevent pressure ulcers. Nonetheless, a substantial proportion indicated a continued need for further education in preventive measures. Conclusion: Despite generally positive attitudes, operating room nurses' knowledge remains insufficient, especially regarding intraoperative positioning. Strengthening pressure ulcer prevention in surgical teams therefore requires structured educational initiatives and clearer role clarification of responsibilities within the surgical team. It is essential to enhance pressure ulcer prevention and improve patient safety. Implications for Nursing Practice: Operating room nurses' positive attitudes towards pressure ulcer prevention provide a strong foundation for practice improvement. Targeted evidence‐based education, competency assessments and enhanced interprofessional collaboration may strengthen preventive practices, reduce intraoperative pressure ulcers and improve patient safety during surgery. Patient or Public Contribution: There was no patient or public contribution.

Aims: To explore patients' fundamental care needs, to which extent they are met and to assess how the care activities of Registered Nurses and assistant nurses are accomplished. A further aim is to investigate their associations with contextual factors in an emergency department setting. Design: Quantitative exploratory observational study with data collected through structured observations. Methods: Seventy‐five patients, 30 registered nurses, and 20 assistant nurses were recruited from one emergency department. Structured observation protocols, spot checks, and follow‐up dialogues were used. Descriptive and analytical statistics were calculated. Results: A total of 812 fundamental care needs were observed: physical (45%), psychosocial (38%), and relational (14%). The prevalence of missed nursing care was 20% and was more prevalent among older patients, those receiving care in shared spaces, and during crowding. In total, 3797 care activities were observed. Medical/technical activities were implemented at a higher rate than integration of care activities; unlike the latter, higher rates were significantly associated with crowding, the surgical section, and registered nurses compared to assistant nurses. Conclusion: Missed nursing care was more prevalent among older patients and those in shared spaces or during crowding. The increased rate of medical/technical care activities was associated with crowding, whereas the integration of care activities remained unchanged. Implications for the Profession and Patient Care: Fast‐track solutions robust to crowding could reduce missed nursing care among older patients. Staff and management should critically assess physical layout in relation to crowding and missed nursing care. Crowding is a system‐level phenomenon representing a significant driver of missed nursing care in the emergency department, and responsibility for addressing this decline in care quality must be acknowledged at system and policy levels. Impact: This study provides evidence of how organizational conditions shape nursing care delivery in emergency departments and will inform interventions to improve care quality and safety. Patient or Public Contribution: None.

Knowledge of healthcare personnel's experiences with quality in palliative care during the COVID-19 pandemic can contribute to quality improvement. The aim of this study was therefore to investigate healthcare personnel's experiences of palliative care quality by identifying strengths and areas for improvement. This study is part of a Norwegian - Swedish multicenter study (PaQC-C19). In total, 268 participants answered two open-ended questions about strengths and areas for improvement, using the Quality from Patient Perspective instrument for palliative care (QPP-PC). Data was analyzed by qualitative content analysis. The findings showed that healthcare personnel’s endeavor to maintain the palliative care quality during the COVID-19 pandemic. Prerequisites for being able to do this included categories about collaboration, access to resources and support from management. Both strengths and areas for improvement were experienced within these categories. The findings highlighted the importance of systems that support healthcare personnel during pandemics and crises and may be transferred to contexts during ordinary conditions.

Background: Providing quality palliative care during a pandemic was challenging. Both specialist and community healthcare services cared for patients that faced life-threatening illness and who were influenced by the restrictions of the COVID-19 pandemic. Little knowledge has yet been provided on how registered nurses (RNs) experienced the palliative care quality during the COVID-19 pandemic. The aim of this study was to explore RN’s experiences of providing palliative care quality during the COVID-19 pandemic. Methods: This qualitative study had a descriptive design. Semi-structured individual interviews were conducted between November 2021 and January 2022 with 18 RNs who worked in intensive care units in hospitals, dementia care or palliative care units in nursing homes in Norway during the pandemic. Data were analysed by using qualitative content analysis. The study was conducted and reported according to the COREQ’s checklist. Results: Analysis of the data resulted in an overall theme: ‘Striving to achieve control’. This theme comprised six categories: (1) when the toolbox does not fit; (2) protective equipment—social distance and opportunities for closeness; (3) unpredictable workday; (4) the right person to the right assignment at the right time; (5) presence and absence of relatives and friends; and (6) situations that required creativity. RNs had various experiences regarding how the quality of care was perceived; being worse, preserved, or in some cases even better than before the pandemic. Conclusions: The provision of quality palliative care was experienced by RNs as challenging during the pandemic. The pandemic forced them to be creative and to strive for control to provide the best palliative care possible given the situation. The results of this study may contribute to important knowledge for leaders, policy makers and RNs to learn from the COVID-19 pandemic and planning for future pandemics or crises. Especially to optimise factors perceived by RNs to be important for the palliative care quality, related to the specific situation and care context, to include the perspectives of those involved and take into consideration the time perspective of the pandemic.

Background and Aims: Several factors exist regarding the risk for, healing and prevention of pressure ulcers (PUs). A mobile PU team with an individualized holistic approach adapted to the home or outpatient clinic setting could be beneficial for the prevention, and management of PUs.Aims: To describe the mobile PU team's interventions among individuals who had deep PUs and were living at home. Another aim was to describe the patients' perceptions of the quality of the care and having a deep PU.Methods: A quantitative study with a cross‐sectional design. At an outpatient clinic, a mobile PU team was established to perform and follow up PU prevention interventions and advanced wound care treatment at home and at the outpatient clinic. All adult patients with existing deep category four PUs remitted to the outpatient clinic were asked to participate, and 16 out of 24 individuals consented. Instruments used for data collection were “Quality from the Patient's Perspective,” “Wound‐Quality of Life,” “Modified Norton Scale,” and a study developed protocol for the mobile team's PU interventions.Results: The patients chose home visits 20 times and outpatient clinic visits 89 times. In total, 8–13 interventions per participant were performed by the mobile team. The results show that having PUs affected the participants' perceptions of care and general well‐being. The PUs did not heal completely but they did improve, six patients underwent flap surgery.Conclusion: When organizing care regarding patient safety for patients with deep PUs, it is important to consider the patient's perspective and well‐being and to involve patients in their care plans. Home care is perhaps not the only way of caring; other aspects, in addition to telemedicine, could be an option.

Incontinence‐associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross‐sectional and case–control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS‐PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the ‘vote counting based on direction’ method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate‐quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low‐quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large‐scale cohort studies in different settings that incorporate our review findings should be conducted in the future.

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.

Background: Strong patient safety culture and effective teamwork are necessary for patient safety. Registered nurses (RNs) and nursing assistants (NAs) work closely with patients, and effective teamwork and communication skills are essential.Aim: To describe and compare the perceptions of patient safety culture, teamwork, and attitudes toward teamwork among RNs and NAs in hospital wards (medical and intensive care), and to explore the potential associations between teamwork and patient safety culture.Methods: A cross‐sectional study was conducted in two hospitals in a single region of Sweden. In one hospital, RNs (n = 103) and NAs (n = 59) in medical care, and RNs (n = 41) and NAs (n = 28) in intensive care were invited to participate. In the other hospital, RNs (n = 67) and NAs (n = 66) involved in medical care were invited. The survey included the Swedish version of Hospital Survey on Patient Safety Culture (S‐HSOPS), the TeamSTEPPS Teamwork Perceptions Questionnaire (T‐TPQ), and the TeamSTEPPS Teamwork Attitudes Questionnaire (T‐TAQ).Results: In total, 155 nurses responded to the survey (response rate = 43%). Overall and in medical care, NAs had a significantly higher score than RNs in “handoffs and transitions” and in intensive care in “information and support to patients and family who have suffered an adverse event” (S‐HSOPS). RNs and NAs in intensive care reported higher scores in “communication” (T‐TPQ) than RNs and NAs in medical care. Overall and in medical care, RNs had more positive attitudes than NAs in total T‐TAQ, “mutual support,” and “communication.” T‐TPQ were associated with “overall perceptions of patient safety” and T‐TAQ were associated with “frequency of error reported.”Conclusion: This study shows differences between RNs and NAs working in medical and intensive care in their perceptions of patient safety culture, teamwork, and attitudes toward teamwork. Teamwork perceptions are important for overall patient safety.

Wound healing is the process by which the function of damaged tissue is restored following surgery, trauma or other sources of tissue damage. The management of wounds is a fundamental aspect of the management of the patient following a fragility fracture, especially following a hip fracture and associated surgery. Ageing skin and multiple comorbidities are significant factors in skin injury and wound healing problems.The effective evidence-based management of surgical wounds following surgery after a fragility fracture can be challenging as ageing and comorbidities affect wound healing. Skin and wound care involves careful skin and wound assessment and attention to infection prevention measures while managing the factors affecting wound healing. Clinical considerations in wound management also include maintaining adequate nutrition, moisture, treating oedema and preventing further injury.This chapter aims to provide an overview of skin and wound assessment and evidence-based care interventions that can optimise wound healing in older people with fragility fractures.