Instrumentos de medición de los conocimientos sobre prevención de úlceras por presiónrevisión de la literatura

  1. María Dolores López-Franco
  2. Pedro Luis Pancorbo-Hidalgo
Revista:
Gerokomos: Revista de la Sociedad Española de Enfermería Geriátrica y Gerontológica

ISSN: 1134-928X

Año de publicación: 2019

Volumen: 30

Número: 2

Páginas: 98-106

Tipo: Artículo

Otras publicaciones en: Gerokomos: Revista de la Sociedad Española de Enfermería Geriátrica y Gerontológica

Resumen

ABSTRACT Different factors (structural, organizational and related with professionals) intervene in the prevention of pressure ulcers (PU); the degree of knowledge of health professionals is one of the main aspects. Aim: To identify the instruments for measuring the knowledge of nursing professionals about pus. The specific objectives are: a) to summarize the psychometric properties (validity and reliability) of each instrument and b) to synthesize the knowledge on prevention according to the selected studies. Methodology: Narrative review on knowledge about PU prevention. Search in 10 bibliographic databases from the beginning of indexation until July 2018. The studies included were quantitative studies that used instruments, tests or questionnaires, which quantified the knowledge of professionals or nursing students. A descriptive synthesis was carried out. Results: 90 articles were selected, from which 7 instruments were identified (or some variation of the original questionnaire) that have been used in at least 2 published studies and 31 investigations, which have developed ad hoc instruments. The 2 most used tools are the Pieper Pressure Ulcer Knowledge (PPKUT) questionnaire and the Pressure Ulcer Knowledge Assessment Tool (PUKAT) questionnaire. Not all published instruments show data on psychometric reliability and validity. Among the 31 studies that describe an ad hoc instrument, only in 5 of them reliability and validity data are shown. Although some studies used Clinical Practice Guidelines as a source for item elaboration, there are many others that are based only in literature review; modified some previous instruments or did not indicate the original source. The knowledge described in the different studies, in general, are below the cut-off point established by the authors. Conclusions: Measuring the knowledge on PU prevention of health professionals is important as a first step in injury prevention programs. A large number of the questionnaires found have any proof of reliability or validity; nevertheless they have been used in studies, which contribute to the generation of irrelevant data and to create confusion. It is essential that researchers use questionnaires with good psychometric properties and these properties should be evaluated again in the sample used in the research.

Referencias bibliográficas

  • García-Fernández, F,Soldevilla-Agreda, JJ,Verdú-Soriano, J,Pancorbo-Hidalgo, P. (2014). A new theoretical model for the development of pressure ulcers and other dependence-related lesions. J Nurs Scholarsh. 46. 28-38
  • (2016). National pressure Ulcer Advisory Panel NPUAPP pressure injury stages. npuap.org. Washington.
  • Pancorbo-Hidalgo, PL,García-Fernández, FP,Rodríguez-Torres, MC,Torres-García, M,López-Medina, IM. (2007). Conocimientos y creencias de las enfermeras sobre el cuidado de las úlceras por presión: revisión sistemática de la literatura. Gerokomos. 18. 188
  • Montenegro de Albuquerque, A,Melo Buriti Vasconcelos, J de,Marques Andrade de Souza, AP,Costa de Lima Chaves, TR,Fernandes Costa, IK,Guimarães Oliveira Soares, MJ. (2018). Knowledge test on pressure injury. Journal of Nursing UFPE/Revista de Enfermagem UFPE. 12. 1738
  • Morales-Asencio, JM,Gonzalo-Jiménez, E,Martin-Santos, F,Morilla-Herrera, JC,Terol-Fernández, J,Ruiz-Barbosa, C. (2003). Guías de práctica clínica: ¿mejoran la efectividad de los cuidados?. Enferm Clin. 13. 41
  • Hernández-Sampieri, R. (2014). Metodología de la investigación. 6. McGrawHill. México.
  • Bostrom, J,Kenneth, H. (1992). Staff nurse knowledge and perceptions about prevention of pressure sores. Dermatol Nurs. 4. 365
  • Provo, B,Piacentine, L,Dean-Baar, S. (1997). Practice versus knowledge when it comes to pressure ulcer prevention. J Wound Ostomy Continence Nurs. 24. 265
  • Hayes, PA,Wolf, ZR,McHugh, MK. (1994). Effect of a teaching plan on a nursing staffs knowledge of pressure ulcer risk, assessment, and treatment. J Nurs Staff Dev. 10. 207
  • Beitz, JM,Fey, J,O’Brien, D. (1998). Perceived need for education vs. actual knowledge of pressure ulcer care in a hospital nursing staff. Medsurg Nurs. 7. 293
  • Pieper, B,Mott, M. (1995). Nurses’ knowledge of pressure ulcer prevention, staging, and description. Adv Wound Care. 8. 34-40
  • Pieper, B,Mattern, JC. (1997). Critical care nurses’ knowledge of pressure ulcer prevention, staging and description. Ostomy Wound Manage. 43. 22
  • Goodridge, D,Biglow, P,LeDoyen, Y,Hordienko, G. (1998). Staff knowledge about pressure ulcer prevention: results of a multi-site study. CAET J. 17. 7-13
  • Caliri, MHL,Miyazaki, MY,Pieper, B. (2003). Knowledge of pressure ulcers by undergraduate nursing students in Brazil. Ostomy Wound Manage. 49. 54-63
  • Rangel, EML. (2004). Conhecimento, práticas e fontes de informação de enfermeiros de um hospital sobre a prevenção e tratamento da úlcera de pressão. Universidade de São Paulo.
  • Sinclair, L,Berwiczonek, H,Thurston, N,Butler, S,Bulloch, G,Ellery, C. (2004). Evaluation of an evidence-based education program for pressure ulcer prevention. J Wound Ostomy Continence Nurs. 31. 43-50
  • Zulkowski, K,Ayello, EA. (2005). Urban and rural nurses’ knowledge of pressure ulcers in the USA. WCET J. 25. 24-30
  • Fernandes, LM,Caliri, MHL,Haas, VJ. (2008). The effect of educative interventions on the pressure ulcer prevention knowledge of nursing professionals. Acta Paulista de Enfermagem. 21. 305
  • Smith, D,Waugh, S. (2009). Research study: an assessment of registered nurses’ knowledge of pressure ulcers prevention and treatment. Kansas Nurse. 84. 3-5
  • Gallant, C,Morin, D,St-Germain, D,Dallaire, D. (2010). Prevention and treatment of pressure ulcers in a university hospital centre: a correlational study examining nurses’ knowledge and best practice. Int J Nursing Pract. 16. 183
  • Machado, TC,Rezende, JF,Borges, EL,Nogueira, VL,Caliri, MH. (2010). Pressure ulcer knowledge among nurses in a Brazilian university hospital. Ostomy Wound Manage. 56. 58-64
  • Miyazaki, MY,Caliri, MHL,Santos, CBd. (2010). Knowledge on Pressure Ulcer Prevention Among Nursing Professionals. Revista latino-americana de enfermagem. 18. 1203
  • Iranmanesh, S,Rafiei, H,Foroogh, A. (2011). Critical care nurses’ knowledge about pressure ulcer in southeast of Iran. Int Wound J. 8. 459
  • Fernandes, NCN,Amaral, J. (2012). Conhecimento da equipe multidisciplinar sobre prevenção, avaliação e tratamento de úlcera de pressão no Hospital Universitário Sul Fluminense/RJ. Estação Científica. 1.
  • Ilesanmi, RE,Ofi, B,Adejumo, PO. (2012). Nurses’ knowledge of pressure ulcer prevention in Ogun state, Nigeria results of a pilot survey. Ostomy Wound Manage. 58. 24-32
  • Iranmanesh, S,Tafti, AA,Rafiei, H,Dehghan, M,Razban, F. (2013). Orthopaedic nurses' knowledge about pressure ulcers in Iran: a cross-sectional study. J Wound Care. 22.
  • Albuquerque, AM,Souza, MA de,Torres, VdSF,Araújo Porto, V de,Torquato, IMB. (2014). Assessment and prevention of pressure ulcer by nurses from intensive care: knowledge and practice. Journal of Nursing UFPE on line. 8. 229
  • Mauricio, AB,Sousa Lemos, D de,Crosewski, NI,Roehrs, H. (2014). Conhecimentos dos profissionais de enfermagem relacionados às úlceras por pressão no centro de terapia semi-intensiva. Revista de Enfermagem da UFSM. 4. 751
  • Soares, R,Saul, A,Silva, R,Timm, A,Bin, A,Durgante, V. (2014). Educational intervention as a process of knowledge construction in the care of pressure ulcers. Rev enferm UFPE on line. 8. 1658
  • Rafiei, H,Abdar, ME,Iranmanesh, S,Lalegani, H,Safdari, A,Dehkordi, AH. (2014). Knowledge about pressure ulcer prevention, classification and management: A survey of registered nurses working with trauma patients in the emergency department. Int J Orthopaedic Trauma Nursing. 18. 135
  • Crosewski, NI,Sousa Lemos, D de,Mauricio, AB,Roehrs, H,Meier, MJ. (2015). Conhecimento dos profissionais de enfermagem sobgre úlceras por pressao em duas unidades cirúrgicas-parte 1. Cogitare Enfermagem. 20.
  • Lawrence, P,Fulbrook, P,Miles, S. (2015). A Survey of Australian Nurses’ Knowledge of Pressure Injury/Pressure Ulcer Management. J Wound Ostomy Continence Nurs. 42. 450
  • Lopes, CM,Andrade, EMLR,Luz, MHBA. (2015). Conhecimento de graduandos de enfermagem sobre úlcera por pressão. Enferm foco (Brasília). 6. 24
  • Rafiei, H,Mehralian, H,Abdar, ME,Madadkar, T. (2015). Pressure ulcers: how much do nursing students really know?. Br J Nurs. 24. 12
  • Rocha, LES,Ruas, EdFG,Santos, JAD,Almeida Lima, C de,Carneiro, JA,Costa, FM da. (2015). Prevenção de úlceras por pressão: avaliação do conhecimento dos profissionais de enfermagem. Cogitare Enfermagem. 20.
  • Baron, MV,Reuter, CP,Burgos, MS,Cavalli, V,Brandenburg, C,Krug, SB. (2016). Experimental study with nursing staff related to the knowledge about pressure ulcers. Revista latino-americana de enfermagem. 24. 2831
  • Ekama Ilesanmi, R,Morohunfoluwa Oluwatosin, O. (2016). A Quasi-experimental Study to Assess an Interactive Educational Intervention on Nurses’ Knowledge of Pressure Ulcer Prevention in Nigeria. Ostomy Wound Manage. 62. 30-40
  • Gul, A,Andsoy, II,Ozkaya, B,Zeydan, A. (2017). A Descriptive, Cross-sectional Survey of Turkish Nurses’ Knowledge of Pressure Ulcer Risk, Prevention, and Staging. Ostomy Wound Manage. 63. 40
  • Marques, ADB,Oliveira Branco, JG de,Costa Cavalcante, R da,Brito, MdCC,Deus, SRM de,Luz, MHBA. (2017). Conhecimento dos Profissionais de Saúde da Família Sobre Úlcera por Pressão. Revista Estima. 15.
  • Miller, DM,Neelon, L,Kish-Smith, K,Whitney, L,Burant, CJ. (2017). Pressure Injury Knowledge in Critical Care Nurses. J Wound Ostomy Continence Nurs. 44. 455
  • Rodríguez-Renobato, R,Esparza-Acosta, GdR,González-Flores, SP. (2017). Conocimientos del personal de enfermería sobre la prevención y el tratamiento de las úlceras por presión. Rev enferm Inst Mex Seguro Soc. 25. 245
  • Souza Galvão, N,Barbosa Serique, MA,Gouveia Santos, VLC de,Nogueira, PC. (2017). Knowledge of the nursing team on pressure ulcer prevention. Revista brasileira de enfermagem. 70. 294-300
  • Tallier, PC,Reineke, PR,Asadoorian, K,Choonoo, JG,Campo, M,Malmgreen-Wallen, C. (2017). Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients. Appl Nurs Res. 36. 106
  • Barakat-Johnson, M,Barnett, C,Wand, T,White, K. (2018). Knowledge and Attitudes of Nurses Toward Pressure Injury Prevention: A Cross-Sectional Multisite Study. J Wound Ostomy Continence Nurs. 45. 233
  • García Fernández, FP,Pancorbo Hidalgo, PL,López Medina, IM,López Ortega, J. (2002). Knowledge and use of the recommendations about prevention and treatment of pressure ulcers in health centers from Andalucía. Gerokomos. 13. 214
  • Zamora Sánches, JJ. (2006). Knowledge and use of the guidelines for prevention and treatment of pressure ulcers in acute-care hospital. Gerokomos. 17. 100
  • Pancorbo-Hidalgo, PL,García-Fernández, FP,López-Medina, IM,López-Ortega, J. (2007). Pressure ulcer care in Spain nurses’ knowledge and clinical practice. J Adv Nurs. 58. 327
  • Hernández Ortiz, JA. (2009). Prevención y cuidados en úlceras por presión: ¿dónde estamos?. Gerokomos. 20. 132
  • Tizón Bouza, E. (2013). Úlceras por presión en urgencias hospitalarias: conocimientos del personal de enfermería y detección de paciente de riesgo. Evidentia. 10.
  • Hulsenboom, MA,Bours, GJ,Halfens, RJ. (2007). Knowledge of pressure ulcer prevention: a cross-sectional and comparative study among nurses. BMC Nursing. 6. 2
  • Meesterberends, E,Wilborn, D,Lohrmann, C,Schols, JM,Halfens, RJ. (2014). Knowledge and use of pressure ulcer preventive measures in nursing homes: a comparison of Dutch and German nursing staff. J Clin Nurs. 23. 1948
  • Kallman, U,Suserud, BO. (2009). Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment--a survey in a Swedish healthcare setting. Scand J Caring Sci. 23. 334
  • Strand, T,Lindgren, M. (2010). Knowledge, attitudes and barriers towards prevention of pressure ulcers in intensive care units: A descriptive cross-sectional study. Intensive Crit Care Nurs. 26. 335
  • Kaddourah, B,Abu-Shaheen, AK,Al-Tannir, M. (2016). Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study. BMC Nursing. 15. 1-6
  • Beeckman, D,Vanderwee, K,Demarre, L,Paquay, L,Hecke, A van,Defloor, T. (2010). Pressure ulcer prevention: development and psychometric validation of a knowledge assessment instrument. Int J Nurs Stud. 47. 399-410
  • Beeckman, D,Defloor, T,Schoonhoven, L,Vanderwee, K. (2011). Knowledge and Attitudes of Nurses on Pressure Ulcer Prevention: A Cross-Sectional Multicenter Study in Belgian Hospitals. Worldviews Evid-Based Nurs. 8. 166
  • Demarre, L,Vanderwee, K,Defloor, T,Verhaeghe, S,Schoonhoven, L,Beeckman, D. (2012). Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes. J Clin Nurs. 21. 1425
  • Cullen Gill, E,Moore, Z. (2013). An exploration of fourth-year undergraduate nurses' knowledge of and attitude towards pressure ulcer prevention. J Wound Care. 22. 618-92022
  • Gunningberg, L,Mårtensson, G,Mamhidir, A-G,Florin, J,Athlin, ÅM,Bååth, C. (2013). Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. Int Wound J. 12. 462
  • Qaddumi, J,Khawaldeh, A. (2014). Pressure ulcer prevention knowledge among Jordanian nurses: a crosssectional study. BMC Nursing. 13. 6
  • Simonetti, V,Comparcini, D,Flacco, ME,Giovanni, P di,Cicolini, G. (2015). Nursing students’ knowledge and attitude on pressure ulcer prevention evidence-based guidelines: A multicenter cross-sectional study. Nurse Educ Today. 35. 573
  • Hultin, L,Olsson, E,Carli, C,Gunningberg, L. (2017). Pressure Mapping in Elderly Care: A Tool to Increase Pressure Injury Knowledge and Awareness Among Staff. J Wound Ostomy Continence Nurs. 44. 142
  • Tirgari, B,Mirshekari, L,Forouzi, MA. (2018). Pressure Injury Prevention: Knowledge and Attitudes of Iranian Intensive Care Nurses. Adv Skin Wound Care. 31. 1-8
  • Usher, K,Woods, C,Brown, J,Power, T,Lea, J,Hutchinson, M. (2018). Australian nursing students' knowledge and attitudes towards pressure injury prevention: A cross-sectional study. Int J Nurs Stud. 81. 14-20
  • Eggink, M. (1991). Pressure ulcer prevention in practice: dissemination of Pressure Ulcer Prevention Consensus among nurses employed in hospitals. Maastricht University.
  • Halfens, RJ,Eggink, M. (1995). Knowledge, beliefs and use of nursing methods in preventing pressure sores in Dutch hospitals. Int J Nurs Stud. 32. 16-26
  • (1985). CBO Consensus Decubitus (Consensus on Pressure Sore Prevention). Centraal Begeleidingsorgaan voor de Intercollegiale Toetsing (Dutch Institute for Healthcare Improvement). Utrecht.
  • Lewin, G,Carville, K,Newall, N,Phillipson, M,Smith, J,Prentice, J. (2013). Determining the effectiveness of implementing theAWMA Guidelines for the prediction and prevention of pressure ulcers, in Silver Chain - a large home care agency. Stage 1: baseline measurement. Prim Intent. 11. 57-860
  • Defloor, T,Herremans, A,Grypdonck, M,Schuijmer, J de,Paquay, L,Bossche, K van den. (2004). Revision of the Belgian guidelines for the prevention of pressure ulcers (Herziening Belgische richtlijnen voor Decubitus-preventie). Verplegingswetenschap Universiteit Gent iov Federaal Ministerie van Sociale Zaken. Brussel.
  • (2005). National Institute for Clinical Excellence The management of pressure ulcers in primary and secondary care: A clinical practice guideline. Royal College of Nursing.
  • (2002). Kwaliteitsinsituut voor de Gezondheidszorg CBO Decubitus: tweede herziening. (Pressure Ulcers: Second Revision). Van Ziden Communications. Alphen aan den Rijn.
  • Defloor, T,Schoonhoven, L,Fletcher, J,Furtado, K,Heyman, H,Lubbers, M. (2005). Statement of the European Pressure Ulcer Advisory Panel-Pressure Ulcer Classification: Differentiation Between Pressure Ulcers and Moisture Lesions. J Wound Ostomy Continence Nurs. 32. 302
  • Tubaishat, A,Aljezawi, M. (2014). Exploring pressure ulcer care in Jordan Nurses’ knowledge and practice. J Dermatol Nurses Assoc. 6. 115
  • Akese, MI,Adejumo, PO,Ilesanmi, RE,Obilor, HN. (2014). Assessment of nurses’ knowledge on evidence-based preventive practices for pressure ulcer risk reduction in patients with impaired mobility. Afr J Med Md Sci. 43. 251
  • Saleh, MY,Qaddumi, JAS,Anthony, D. (2012). An interventional study on the effects of pressure ulcer education on Jordanian registered nurses' knowledge and practice. Procedia-Social and Behavioral Sciences. 47. 2196
  • Nuru, N,Zewdu, F,Amsalu, S,Mehretie, Y. (2015). Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC Nursing. 14. 1-8
  • Islam, S. (2010). Nurses' knowledge, attitude, and practice regarding pressure ulcer prevention for hospitalized patients at Rajshahi medical college hospital in Bangladesh. Prince of Songkla University.
  • Drake, J,Redfern, WS,Sherburne, E,Nugent, ML,Simpson, P. (2012). Pediatric skin care: What do nurses really know?. J Spec Pediatr Nurs. 17. 329
  • Panagiotopoulou, K,Kerr, SM. (2002). Pressure area care: an exploration of Greek nurses’ knowledge and practice. J Adv Nurs. 40. 285
  • Aydin, AK,Karadag, A. (2010). Assessment of nurses’ knowledge and practice in prevention and management of deep tissue injury and stage I pressure ulcer. J Wound Ostomy Continence Nurs. 37. 487
  • Saleh, MY,Al-Hussami, M,Anthony, D. (2013). Pressure ulcer prevention and treatment knowledge of Jordanian nurses. J Tissue Viability. 22. 1-11
  • Leyva Moral, JM. (2008). Docencia, conocimientos y expectativas sobre el abordaje de las úlceras por presión entre los alumnos de tercer curso de enfermería. Ágora de enfermería. 12. 2
  • Tweed, C,Tweed, M. (2008). Intensive care nurses’ knowledge of pressure ulcers: development of an assessment tool and effect of an educational program. Am J Crit Care. 17. 338
  • Sutherland-Fraser, S,McInnes, E,Maher, E,Middleton, S. (2012). Peri-operative nurses’ knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study. BMC Nursing. 11. 25
  • Haixia, F,Guohong, L,Cuirong, X,Changping, J. (2016). Educational campaign to increase knowledge of pressure ulcers. Br J Nurs. 25. 30
  • González-Consuegra, RV,Pérez-Valderrama, DC,Valbuena-Flor, LF. (2016). Prevention of skin lesions: Education in health staff and relatives of people hospitalized. Revista Facultad de Medicina. 64. 229
  • Cuya Arias, HJ. (2015). Conocimientos del profesional de enfermería sobre las medidas de prevención de úlceras por presión en pacientes de la Unidad de Cuidados Intensivos del Hospital Central FAP 2014.
  • Gupta, N,Loong, B,Leong, G. (2012). Comparing and contrasting knowledge of pressure ulcer assessment, prevention and management in people with spinal cord injury among nursing staff working in two metropolitan spinal units and rehabilitation medicine training specialists in a three-way. Spinal Cord. 50. 159
  • Gunningberg, L,Lindholm, C,Carlsson, M,Sjoden, PO. (2001). Risk, prevention and treatment of pressure ulcers--nursing staff knowledge and documentation. Scand J Caring Sci. 15. 257
  • Dallarosa, FS,Braquehais, AR. (2016). Nurse’s knowledge on the prevention of ulcers by pressure in a intensive therapy unit/Conhecimento dos enfermeiros acerca da prevenção de lesões por pressão em unidade de terapia intensiva/Conocimiento del enfermero sobre la prevención de úlceras. Revista de Enfermagem da UFPI. 5. 13
  • Restrepo Medrano, JC,Tirado Otalvaro, AF,Milena Velásquez Vergara, S,Velásquez García, KY. (2015). Conocimientos relacionados con el manejo de úlceras por presión que tienen los estudiantes de enfermería de una universidad de Medellín, Colombia. Gerokomos. 26. 68-72
  • Mwebaza, I,Katende, G,Groves, S,Nankumbi, J. (2014). Nurses’ knowledge, practices, and barriers in care of patients with pressure ulcers in a ugandan teaching hospital. Nurs Res Pract. 2014. 973602
  • Minami, LF,Santos, PTD,Ferrari, CRS,Ciampone, MHT,Messas, JT,Mira, VL. (2012). Evaluation of the ‘Pressure Ulcer Prevention and Treatment’ training program given to the nursing team. Revista Eletronica de Enfermagem. 14. 663
  • Hinojosa Caballero, D. (2012). Conocimiento de los profesionales de urgencias sobre la prevención y tratamiento de las úlceras por presión. Gerokomos. 23. 182
  • El Enein, NY,Zaghloul, AA. (2011). Nurses’ knowledge of prevention and management of pressure ulcer at a health insurance hospital in Alexandria. Int J Nurs Pract. 17. 262
  • Quesada Ramos, C,García Díez, R. (2008). Evaluation of the grade of knowledge of the recommendations for the prevention and care of pressure sores in Critical Units. Enferm Intensiva. 19. 23-34
  • Snarska, K,Jarocka, I,Sieriantowicz, R,Lagoda, K,Jurkowska, G. (2005). The knowledge of bedsores prevention among Health and Nursing Department students of Medical University of Bialystok. Roczniki Akademii Medycznej w Bialymstoku. 50. 193
  • Esperón Güimil, JA,Vázquez Vizoso, FL. (2004). Nurses’ knowledges [sic] about pressure ulcers and their determinants. Gerokomos. 15. 107
  • Russell, L. (1996). Knowledge and practice in pressure area care. Professional Nurse. 11. 301
  • Wilkes, LM,Bostock, E,Lovitt, L,Dennis, G. (1996). Nurses’ knowledge of pressure ulcer management in elderly people. Br J Nurs. 5. 858
  • Valença, MP,Lima, PO de,Mota Pereira, M da,Santos, RB. (2010). Nurses' perception on the prevention of pressure ulcers at a hospital school in Recife city. J Nursing UFPE on line. 4. 673
  • Altun, I,Demir Zencirci, A. (2011). Knowledge and management of pressure ulcers: impact of lecture-based interactive workshops on training of nurses. Adv Skin Wound Care. 24. 262
  • Dilie, A,Mengistu, D. (2015). Assessment of nurses' knowledge, attitude, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals, Addis Ababa, Ethiopia, 2015. Adv Nursing.
  • Streiner, DL. (2003). Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 80. 99-103
  • Constantino-Casas, P,Viniegra-Osorio, A,Medécigo-Micete, C,Torres-Arreola, LdP,Valenzuela-Flores, A. (2009). El potencial de las guías de práctica clínica para mejorar la calidad de la atención. Revista Médica del Instituto Mexicano del Seguro Social. 47.
  • Thomas, L,McColl, E,Cullum, N,Rousseau, N,Soutter, J,Steen, N. (1998). Effect of clinical guidelines in nursing, midwifery, and the therapies: a systematic review of evaluations. BMJ Quality Safety. 7. 183
  • Pieper, B,Zulkowski, K. (2014). The Pieper-Zulkowski pressure ulcer knowledge test. Adv Skin Wound Care. 27. 413
  • Manderlier, B,Damme, N van,Vanderwee, K,Verhaeghe, S,Hecke, A van,Beeckman, D. (2017). Development and psychometric validation of PUKAT 2.0 a knowledge assessment tool for pressure ulcer prevention. Int Wound J. 14. 1041
  • López-Franco, M,Pancorbo-Hidalgo, PL. (2017). Cuestionario de conocimientos sobre prevención de úlceras por presión CPUPP-37: elaboración y validación de contenido. Gerokomos. 28. 30