SCIENCE, PRACTICE AND EDUCATION INTRODUCTION Skin tears are defined as ‘a traumatic wound caused by mechanical forces, including removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer)’. 1 Skin tears occur across all healthcare settings and are related to mechanical trauma such as wheelchairs, adhesive tapes’ removal, transfers or falls. 1–5 Their prevalence ranges from 3% to 41% in long-term care settings 5–14 , 1.1% to 11.4% in acute care 15–20 , 3.3% to 27% in palliative care 19,21,22 and 0.10% to 17% in paediatrics. 23,24 Evi- dence shows that these wounds are often unreported, misdiagnosed and that their clinical and financial impact on the healthcare system is not clearly de- scribed. 25,26 In addition, the impact of skin tears on the individual is poorly described, but they appear to cause pain and impair quality of life. 25,26 Current guidelines recommend an interdisciplinary team approach to implementing a systematic skin tear prevention programme. 1 Good skin tear man- agement includes interventions involving both the patient and the caregivers 1,27 , such as ensuring safe patient handling techniques/equipment or a secure environment; wearing long sleeves, long pants/trou- sers or knee-high socks; and keeping fingernails and toenails short. 3,27 The knowledge base used in skin tear care requires an understanding of the physiology of the skin, which helps in the management of people with skin tears. When a skin tear occurs, effective care should be based on preserving the skin flap and the surrounding tissue and the re-approximation of the wound’s edges, reducing the risk of infection and further injuries while considering any comorbidities. 1 Studies have demonstrated a gap between evidence and clinical practices regarding skin tear prevention and management 13,28 , due to a lack of information and expertise, inadequate communication and lim- ited access to evidence on assessment. 13 White 28 investigated the knowledge, opinions and clinical practices about skin tears of nurses working in nurs- ing home/residential aged care facilities using a survey method. The results showed that fewer than 50% of the nurses documented the shape of the skin tear, amount of skin lost, depth of the wound or condition of the surrounding skin, and only 24% indicated that their facility had a ‘standard’ for the treatment and management of skin tears. 28 Another survey evaluat- ing skin tear knowledge of acute care nurses working in two hospitals showed improved knowledge in skin tear identification and assessment, classification and treatment (97.1%, versus 99.1%). 29 A larger study investigated current practices in assessing, predicting, preventing and treating skin tears among health care providers from 16 countries and revealed problems with the current methods for skin tear assessment and documentation (69.6%). Fully 80.9% mentioned that tools or classification systems are not used. 30 A survey on acute care nurses’ knowledge of skin tear assessment, prevention and treatment found a lack of knowledge and awareness of risk factors, preven- tion strategies and skin tear treatment based on the literature. 31 A recent study from Germany confirmed nurses’ lack of knowledge on the international clas- sification system, prevention and treatment. 32 With the above in mind, we aimed to investigate nurses’ perceptions, opinions, knowledge and clinical practices related to the prevention and management of skin tears in French-speaking Switzerland. METHODOLOGY A quantitative, non-experimental descriptive research approach with a survey was employed. A survey ques- tionnaire developed by White 28 was identified and translated into French. 33 It was distributed among wound care nurses who hold a Certificate or a Diplo- ma of Advanced Studies degree (CAS/DAS HES-SO) in wound care recruited via the University of Applied Sciences and Arts Western Switzerland and the Swiss Association for Wound Care (SAfW-Romande) be- tween 17 November and 14 December 2020. The survey was sent via an email that also explained the purpose of the study. Prospective participants were invited to answer the online survey through the link provided in the email. Since the survey was anony- mous, there was no follow-up on the respondents and non-respondents. Two weeks later, a reminder was sent to all participants. The survey was closed after four weeks. The questionnaire was divided into four sections, with the first focussed on general information about the nurses’ education and the institution within which they worked. The second section assessed their perceptions of skin tears; the third inquired about knowledge of skin tears’ definition and classification; the fourth section addressed clinical issues and dif- ficulties relating to the prevention, management and treatment of skin tears. We analysed the data using descriptive statistical analysis. All open-ended ques- tions were analysed using thematic analysis with a deductive approach, according to Braun and Clarke’s 79 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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