SCIENCE, PRACTICE AND EDUCATION study showed no uniform language used related to the description and classification of skin tears. Aging skin issues, risk assessment, skin tear classification, local wound management and preventative strategies were identified as important elements for future edu- cational programmes. 4 A recent study in Germany exploring nurses’ knowledge of skin tears 5 showed that they do not know the international classification system for skin tears and lack knowledge on their prevention and treatment. The authors recommend that education on skin tears should start in nursing school and at the nursing college level. 5 Given the lack of research in this area, it is impor- tant for both policymaking and improving patient outcomes that we understand the situation in Swit- zerland, as the current literature is not sufficiently generalisable to this setting. The aim of this study is to translate and cross-cul- turally adapt an original English-language survey conducted by White 4 in Australia into Swiss French, based on the seven-step methodology outlined by Sousa and Rojjanasrirat. 6 METHOD Survey In 2001, White 4 conducted a survey on the opin- ions, clinical practice and knowledgebase of Aus- tralian Registered Nurses concerning skin tears. The questionnaire was based on a literature review that included both open- and closed-ended questions, including: sociodemographic questions, nurses’ opinions on the incidence of skin tears, reporting, assessment and documentation. The authors explored nurses’ skin tear-related clinical practices, knowledge and education by asking questions on the definition and classification of tears, aging skin, risk factors, prevention strategies, educational programmes and existing literature. 4 The translation process There are different methodological approaches for translating, adapting and validating instruments or scales for use in research. Unfortunately, the use of multiple processes leads to wide variations in health care literature and research. In this study, five out of the seven steps proposed by Sousa and Rojjanasrirat 6 were adapted and deemed applicable to this context (see Figure 1). According to Sousa and Rojjanasrirat 6 , in Step 1, the original instrument must be translated by at least two independent, bilingual translators. They point out that the translators should have different backgrounds, one with knowledge of healthcare ter- minology and the other fluent in colloquialisms and popular expressions used in the desired language. It is preferable for the latter to have no knowledge of either medical terms or the construction of the in- strument being translated. 6 With this in mind, we worked with two bilingual experts with a health sci- ence background to complete a forward translation of the survey from English to Swiss French (TL1 and TL2). The choice to use translators with similar backgrounds was due to unavailable resources for meeting the full prerequisites outlined by Sousa and Rojjanasrirat. In Step 2 of Sousa and Rojjanasrirat’s process 6 , a third independent translator compares the two translated versions and the original version of the instrument, to detect any hesitations and ambiguities. Ambiguities must be discussed and a consensus obtained from a committee composed of the third translator, the translators from Step 1 and the research team. This process engenders the ‘preliminary initial translated version of the instrument (PI–TL)’. 6 Step 2 was adapted for this study because no third translator was used, again due to a lack of resources. The research team achieved consensus for the PI–TL version. Skin tear prevention and treatment guidelines are now available 1 , and the initial questions on nurses’ opinions on clinical practice related to skin tear treat- ment and prevention have been updated accordingly in the 2020 survey. White used Payne and Martin’s 7 definition of skin tears in her survey. This was also an opportunity to document which, if any, classifica- tion system nurses used in their clinical practice. The present study uses the validated French translation of the ISTAP definition and classification. 8,9 In Step 3, the preliminary translated version (PI–TL) is translated back into the original language. This step requires two new translators whose mother tongue matches the original instrument. The same preroga- tives as Step 1 apply to both translators in Step 3, and they should be unaware of the original version of the instrument. This results in two back-translat- ed versions of the original instrument (B-TL1 and B-TL2). 6 In this study, two different experts back- translated the PI–TL from Swiss French into English in a blinded fashion. 46 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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