Dear Editor,

As Program Coordinator of an Associate Degree Nursing Program and a certified wound care nurse (formerly CWOCN), I read Garrigues, Cartwright, and Bliss's article, "Attitudes of Nursing Students About Pressure Injury Prevention," in the March/April issue with great interest. I have some comments. The Oregon Health Sciences Nursing Program is regarded in nursing education circles as one of the most innovative programs in the country. The program is part of the Oregon Consortium for Nursing Education and its focus is competency-based nursing.1 In 2010, the American Association of Colleges of Nursing (the accrediting organization for the Oregon Health Sciences Nursing Program) outlined 19 geriatric nursing competencies.2 Included in this list is competency 17, which directly states: "Implement and monitor strategies to prevent risk and promote quality and safety (e.g., falls, medication mismanagement, pressure ulcers) in the nursing care of older adults with physical and cognitive needs."2 The following statement from the article concerns me. "Most students did not recollect learning about pressure injury prevention in any theory course, simulation, or skills laboratory activity."3 The authors did not address this statement in the discussion section of their findings. I would hope that based upon this information, the nursing program is planning to assess and evaluate its current curriculum. As the authors know, per the National Council of State Boards of Nursing's 2014 Practice Analysis, 50% of current nursing program graduates are responsible for the care of acutely ill patients and nearly 50% of new graduates are employed in medical/surgical and critical care nursing units. The study also noted that 54.3% of new graduate were caring for patients between the ages of 65 and 85 years.4 New graduate nurses need to be aware of best practices for pressure injury prediction, assessment, prevention, and management, as they will be integrally involved with quality improvement initiatives.

I also have a question about the participants in the study. Some of the participants were graduates of associate degree (AD) nursing programs. The authors were not clear whether generic undergraduate students and the AD graduates (I assume they were enrolled as undergraduate students and not RN to BSN students) had similar clinical experiences. I know that in many parts of the county, because of limited clinical sites, AD nursing students are often assigned to long-term care facilities for 1 to 2 semesters. I am curious about the students who were "committed to pressure injury prevention" or "passionate about pressure injury practices."3 Did the author determine if these were generic bachelor's students or AD transfer students or a combination of both? Since the focus of many AD nursing programs is "hands-on" care, I would be interested in this breakdown. Students in the school where I am an administrator have a great deal of experience with acute and chronic wounds during their 4 semesters. Since some of the participants in this study were graduates of AD programs, did their previous clinical experiences impact either positively or negatively their perceptions of pressure injury prevention?

Again, I want to thank the authors for this interesting study.

Sincerely,

Tracey J. Siegel, EdD, MSN, RN, CNE, CWCN

Old Bridge, New Jersey

1. Oregon Consortium for Nursing Education. Curriculum basics. http://ocne.org/students/Curriculum.html. Accessed March 30, 2017. [Context Link]

2. American Association of Colleges of Nursing. Recommended baccalaureate competencies and curricular guidelines for the nursing care of older adults. http://http://www.aacn.nche.edu/geriatric-nursing/AACN_Gerocompetencies.pdf. Published 2010. Accessed March 30, 2017. [Context Link]

3. Garrigues LJ, Cartwright JC, Bliss DZ. Attitudes of nursing students about pressure injury prevention. J Wound Ostomy Continence Nurs. 2017;44(2):123-127. [Context Link]

4. National Council of State Boards of Nursing. 2014 RN practice analysis: linking the NCLEX-RN examination to practice. https://http://www.ncsbn.org/15_RN_Practice_Analysis_Vol62_web.pdf. Accessed March 30, 2017. [Context Link]

Response to Letter to the Editor

Re: Attitudes of Nursing Students About Pressure Injury Prevention

Dear Editor,

We want to thank Dr Tracey Siegel for taking the time to respond to our article, "Attitudes of Nursing Students About Pressure Injury Prevention," from the March/April issue of JWOCN. As faculty at Oregon Health & Science University (OHSU), we are required to obtain OHSU Institutional Review Board approval for research studies. Participants were not identified by school/program in the publication. As Dr Siegel mentions, we reported that students did not recall certain learning in their course work. This is an ongoing issue for any school of nursing curriculum. Students do not necessarily remember all content they had in courses or what content was provided when.1 This exploratory study did not investigate curricular content or compare student experiences with what faculty perceive is covered in a course. Rather, our goal was to identify student perceptions about and experiences with pressure injury prevention (PIP) and to use the findings as the basis for further studies on what learning experiences may best support development of professional competence and accountability for skin care. In this study, students identified hands-on, clinical experiences as the most memorable for learning about PIP. The school of nursing where the research was conducted uses multiple instructional modalities and experiences to support student learning about PIP. This study identifies the experiences that students recalled as helping them recognize and value PIP. The faculty will use these findings in their ongoing refinement of the curriculum.

In response to Dr Siegel's question about differences between traditional undergraduate and associate degree to bachelor's degree completion students, the 2 groups were similar in terms of experiences they recalled and their perceptions associated with PIP. One group of students did not express a higher commitment to PIP than the other. These similarities may be related to the common lower division curriculum that the programs share.

Again, we appreciate the thoughtful comments from Dr Siegel.

Sincerely,

Layla J. Garrigues, PhD, RN

Portland, Oregon

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