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Journal for Specialists in Pediatric Nursing
L E T T E R TO T H E E D I TO R
Re: Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age
Search terms Pressure ulcers, children, medical devices. doi: 10.1111/jspn.12065
As clinicians and researchers interested in hospitalacquired pressure ulcers (HAPUs) in children, we continually seek collaborative opportunities nationally and internationally to address this important issue and advance the state of the science as it relates to this evolving area of pediatric nursing. We appreciate the ongoing efforts by AnnaBarbara Schlüer, MScN, and colleagues to identify factors related to the development of HAPUs in the pediatric population. In a JSPN early view (online version of record published before inclusion in an issue) publication, Schlüer, Schols, and Halfens (2014) conducted a multicenter, cross-sectional, descriptive study to explore factors associated with HAPUs in children and adolescents. The authors used the Braden Scale vs. the Braden Q Scale for predicting pediatric pressure ulcer risk, which is a widely used, valid, and reliable pediatric-specific pressure ulcer risk assessment tool (Noonan, Quigley, & Curley, 2006). It is unclear why Schlüer and colleagues would use the original Braden Scale, which has never been psychometrically tested with any age group in the pediatric population. Instead, it was developed and tested for the adult population. It is also unclear why the authors did not use the Braden Q Scale, which has been translated into German (Die Braden Q-skala: Dekubitus-risiko bei kindern, 2005). Additionally, Schlüer and colleagues (2014) did not separate traditional immobility-related from devicerelated pressure ulcers. The Braden Scale does not predict device-related injuries. Researchers have emphasized the importance of clinicians recognizing that risk assessment, prevention, and management of immobility-related and medical device-related pressure ulcers are different (Kohr & Curley, 2010). In order to avoid confusion regarding implementation of best practice recommendations for HAPU prevention and quality monitoring, it is critically important Journal for Specialists in Pediatric Nursing 19 (2014) 105–106 © 2014, Wiley Periodicals, Inc.
to differentiate the two phenomena (Murray, Noonan, Quiqley, & Curley, 2013). As nursing experts continue to contribute to the science of HAPUs in the pediatric population, greater collaboration and open dialogue is needed so that the experiences of all who are interested in this important issue are considered. The enduring commitment to refining a psychometrically sound risk assessment tool for HAPUs is critical to informing nursing practice and optimizing prevention and treatment (Murray et al., 2013). John S. Murray, PhD, RN, CPNP, CS, FAAN [email protected] Independent Nurse Consultant Brookline, Massachusetts, USA Sandy Quigley, RN, CWOCN, CPNP [email protected] Boston Children’s Hospital Boston, Massachusetts, USA Martha A.Q. Curley, RN, PhD, FAAN [email protected] Ellen and Robert Kapito Professor in Nursing Science School of Nursing Anesthesia and Critical Care Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA References Die Braden Q-skala: Dekubitus-risiko bei kindern. (2005). Heilberufe Spezial: Praxis+Bildung: Grundlagen. 18–19. Kohr, L. M., & Curley, M. A. (2010). Small study finds 27.7% prevalence of pressure ulcers in paediatric hospitals in Switzerland, with many cases caused by external medical devices. Evidence-Based Nursing, 13, 58. Murray, J. S., Noonan, C., Quigley, S., & Curley, M. (2013). Medical device-related hospital-acquired 105
Letter to the Editor
pressure ulcers in children: An integrative review. Journal of Pediatric Nursing, 28, 585–595. doi:10.1016/ j.pedn.2013.05.004 Noonan, C., Quigley, S., & Curley, M. (2006). Skin integrity in hospitalized infants and children: A prevalence survey. Journal of Pediatric Nursing, 21, 445–453.
106
J. S. Murray et al.
Schlüer, A. B., Schols, J. M., & Halfens, R. J. (2014). Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age. Journal for Specialists in Pediatric Nursing, 19(1), 80–89. doi:10.1111/jspn.12055
Journal for Specialists in Pediatric Nursing 19 (2014) 105–106 © 2014, Wiley Periodicals, Inc.
Journal for Specialists in Pediatric Nursing
L E T T E R TO T H E E D I TO R
Re: Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age
Search terms Pressure ulcers, children, medical devices. doi: 10.1111/jspn.12065
As clinicians and researchers interested in hospitalacquired pressure ulcers (HAPUs) in children, we continually seek collaborative opportunities nationally and internationally to address this important issue and advance the state of the science as it relates to this evolving area of pediatric nursing. We appreciate the ongoing efforts by AnnaBarbara Schlüer, MScN, and colleagues to identify factors related to the development of HAPUs in the pediatric population. In a JSPN early view (online version of record published before inclusion in an issue) publication, Schlüer, Schols, and Halfens (2014) conducted a multicenter, cross-sectional, descriptive study to explore factors associated with HAPUs in children and adolescents. The authors used the Braden Scale vs. the Braden Q Scale for predicting pediatric pressure ulcer risk, which is a widely used, valid, and reliable pediatric-specific pressure ulcer risk assessment tool (Noonan, Quigley, & Curley, 2006). It is unclear why Schlüer and colleagues would use the original Braden Scale, which has never been psychometrically tested with any age group in the pediatric population. Instead, it was developed and tested for the adult population. It is also unclear why the authors did not use the Braden Q Scale, which has been translated into German (Die Braden Q-skala: Dekubitus-risiko bei kindern, 2005). Additionally, Schlüer and colleagues (2014) did not separate traditional immobility-related from devicerelated pressure ulcers. The Braden Scale does not predict device-related injuries. Researchers have emphasized the importance of clinicians recognizing that risk assessment, prevention, and management of immobility-related and medical device-related pressure ulcers are different (Kohr & Curley, 2010). In order to avoid confusion regarding implementation of best practice recommendations for HAPU prevention and quality monitoring, it is critically important Journal for Specialists in Pediatric Nursing 19 (2014) 105–106 © 2014, Wiley Periodicals, Inc.
to differentiate the two phenomena (Murray, Noonan, Quiqley, & Curley, 2013). As nursing experts continue to contribute to the science of HAPUs in the pediatric population, greater collaboration and open dialogue is needed so that the experiences of all who are interested in this important issue are considered. The enduring commitment to refining a psychometrically sound risk assessment tool for HAPUs is critical to informing nursing practice and optimizing prevention and treatment (Murray et al., 2013). John S. Murray, PhD, RN, CPNP, CS, FAAN [email protected] Independent Nurse Consultant Brookline, Massachusetts, USA Sandy Quigley, RN, CWOCN, CPNP [email protected] Boston Children’s Hospital Boston, Massachusetts, USA Martha A.Q. Curley, RN, PhD, FAAN [email protected] Ellen and Robert Kapito Professor in Nursing Science School of Nursing Anesthesia and Critical Care Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA References Die Braden Q-skala: Dekubitus-risiko bei kindern. (2005). Heilberufe Spezial: Praxis+Bildung: Grundlagen. 18–19. Kohr, L. M., & Curley, M. A. (2010). Small study finds 27.7% prevalence of pressure ulcers in paediatric hospitals in Switzerland, with many cases caused by external medical devices. Evidence-Based Nursing, 13, 58. Murray, J. S., Noonan, C., Quigley, S., & Curley, M. (2013). Medical device-related hospital-acquired 105
Letter to the Editor
pressure ulcers in children: An integrative review. Journal of Pediatric Nursing, 28, 585–595. doi:10.1016/ j.pedn.2013.05.004 Noonan, C., Quigley, S., & Curley, M. (2006). Skin integrity in hospitalized infants and children: A prevalence survey. Journal of Pediatric Nursing, 21, 445–453.
106
J. S. Murray et al.
Schlüer, A. B., Schols, J. M., & Halfens, R. J. (2014). Risk and associated factors of pressure ulcers in hospitalized children over 1 year of age. Journal for Specialists in Pediatric Nursing, 19(1), 80–89. doi:10.1111/jspn.12055
Journal for Specialists in Pediatric Nursing 19 (2014) 105–106 © 2014, Wiley Periodicals, Inc.
