Scholars@Duke
Tracey L. Yap

Tracey L. Yap

Professor in the School of Nursing
School of Nursing
tracey.yap@duke.edu
DUMC 3322, Durham, NC 27710
311 Trent Drive, DUMC 3322, Durham, NC 27710

Selected Publications

Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost-effectiveness analysis of the 'TEAM-UP' clinical trial.

Journal Article International wound journal · March 2024 Pressure injury (PrI) prevention guidelines recommend 2-h repositioning intervals in healthcare settings, requiring significant nursing time investment. We analysed the cost-effectiveness of PrI prevention protocols with 2-, 3- and 4-h repositioning interv ... Full text Cite

WHS guidelines for the treatment of pressure ulcers-2023 update.

Journal Article Wound Repair Regen · 2024 The major populations at risk for developing pressure ulcers are older adults who have multiple risk factors that increase their vulnerability, people who are critically ill and those with spinal cord injury/disease. The reported prevalence of pressure ulc ... Full text Link to item Cite

Using an Electromagnetic Guidance System for Placement of Small-Bowel Feeding Tubes to Reduce Feeding Start Times.

Journal Article Critical care nurse · February 2023 BackgroundCardiothoracic surgery patients have an increased risk for aspiration and may require enteral access for nutrition.Local problemIn a cardiothoracic intensive care unit, feeding start times were delayed because of scheduling conf ... Full text Cite

The Nursing Home Severity Index and Application to Pressure Injury Risk: Measure Development and Validation Study.

Journal Article JMIR aging · February 2023 BackgroundAn assessment tool is needed to measure the clinical severity of nursing home residents to improve the prediction of outcomes and provide guidance in treatment planning.ObjectiveThis study aims to describe the development of the ... Full text Cite

Movement Patterns of Transient and Prolonged Positioning Events in Nursing Home Residents: Results from the TEAM-UP Trial.

Journal Article Advances in skin & wound care · December 2022 ObjectiveTo characterize transient and prolonged body position patterns in a large sample of nursing home (NH) residents and describe the variability in movement patterns based on time of occurrence.MethodsThis study is a descriptive, exp ... Full text Cite

Nursing Assessment of Pressure Injury Risk with the Braden Scale Validated against Sensor-Based Measurement of Movement.

Journal Article Healthcare (Basel, Switzerland) · November 2022 Nursing staff assessment to accurately identify pressure injury (PrI) risk is a hallmark in PrI prevention care. Risk scores from the Braden Scale for Predicting Pressure Sore Risk© (hereafter Braden), a commonly used tool for assessing PrI risk ... Full text Cite

Improving Pressure Injury Prevention by Using Wearable Sensors to Cue Critical Care Patient Repositioning.

Journal Article American journal of critical care : an official publication, American Association of Critical-Care Nurses · July 2022 BackgroundRepositioning patients at regular intervals is the standard of care for pressure injury prevention, yet compliance with routine repositioning schedules can be hard to achieve in busy critical care environments. Cueing technology may help ... Full text Cite

Effect of Varying Repositioning Frequency on Pressure Injury Prevention in Nursing Home Residents: TEAM-UP Trial Results.

Journal Article Adv Skin Wound Care · June 1, 2022 OBJECTIVE: To investigate the clinical effectiveness of three nursing-home-wide repositioning intervals (2-, 3-, or 4-hour) without compromising pressure injury (PrI) incidence in 4 weeks. METHODS: An embedded pragmatic cluster randomized controlled trial ... Full text Link to item Cite

Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit.

Journal Article AACN advanced critical care · June 2022 BackgroundPatients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury.MethodsBraden Scale predictive validity was compared between patients with and without COVID-19, a ... Full text Cite

Characteristics of Nursing Home Resident Movement Patterns: Results from the TEAM-UP Trial.

Journal Article Advances in skin & wound care · May 2022 ObjectiveTo determine movement patterns of nursing home residents, specifically those with dementia or obesity, to improve repositioning approaches to pressure injury (PrI) prevention.MethodsA descriptive exploratory study was conducted u ... Full text Cite

Implementation of Nurse-Led Cognitive Screening During Medicare Annual Wellness Visits

Journal Article Journal for Nurse Practitioners · May 1, 2022 Dementia is a serious and costly illness. Early identification of cognitive impairment provides opportunity for earlier intervention, and there is growing evidence suggesting that early intervention may help delay the onset of dementia. There is limited co ... Full text Cite

Increasing Nursing Documentation Efficiency With Wearable Sensors for Pressure Injury Prevention.

Journal Article Critical care nurse · April 2022 BackgroundDocumentation presents an overwhelming burden to bedside clinical nurses. Nurses must manually enter several hundred data points into electronic health record flow sheets, taking time from direct patient care and introducing opportunity ... Full text Cite

Cognitive Screening Before the Medicare Annual Wellness Visit

Journal Article Journal for Nurse Practitioners · February 1, 2022 Dementia is a devastating illness with increasing prevalence, possibly due to the pervasiveness of untreated modifiable risk factors. While early identification and treatment can improve outcomes, few standardized screening protocols exist. Primary care is ... Full text Cite

The Past, Present, and Future of Deep-Tissue (Pressure) Injury.

Journal Article Advances in skin & wound care · February 2022 Full text Cite

Implementation of Photoscreening to Improve the Preschool Vision Screening Process

Journal Article Journal for Nurse Practitioners · September 1, 2021 Amblyopia is the most common cause of preventable visual impairment in childhood. A quality improvement project was conducted at a pediatric primary care clinic located in North Carolina over a 3-month period with the intent of improving the preschool visi ... Full text Cite

Subsequent Pressure Injury Development in Mechanically Ventilated Critical Care Patients with Hospital-Acquired Pressure Injury: A Retrospective Cohort Study.

Journal Article Advances in skin & wound care · August 2021 ObjectiveTo identify factors associated with subsequent hospital-acquired pressure injury (HAPrI) formation among patients in surgical and cardiovascular surgical ICUs with an initial HAPrI.MethodsPatients admitted to a level 1 trauma cen ... Full text Cite

Angiosomal Vascular Occlusions, Deep-Tissue Pressure Injuries, and Competing Theories: A Case Report.

Journal Article Advances in skin & wound care · March 2021 AbstractCompression of the soft tissue between a support surface and a bony prominence has long been the accepted primary mechanism of pressure injury (PrI) formation, with the belief that said compression leads to capillary occlusion, ischemia, a ... Full text Cite

Hospital acquired pressure injury prediction in surgical critical care patients.

Journal Article BMC medical informatics and decision making · January 2021 BackgroundHospital-acquired pressure injuries (HAPrIs) are areas of damage to the skin occurring among 5-10% of surgical intensive care unit (ICU) patients. HAPrIs are mostly preventable; however, prevention may require measures not feasible for e ... Full text Cite

To Turn or Not to Turn: Exploring Nurses' Decision-Making Processes Concerning Regular Turning of Nursing Home Residents.

Journal Article Gerontology & geriatric medicine · January 2021 Background: Nursing home (NH) residents are at high-risk for pressure injuries (PrIs), and those living with Alzheimer's Disease and Related Dementias (ADRD) are at even greater risk. Understanding how nursing staff approach repositioning remains cr ... Full text Cite

Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study

Journal Article JMIR Dermatology · 2021 BackgroundUnderstanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the de ... Full text Cite

Risk Factors for Hospital-Acquired Pressure Injury in Surgical Critical Care Patients.

Journal Article American journal of critical care : an official publication, American Association of Critical-Care Nurses · November 2020 BackgroundHospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined ... Full text Cite

Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury: A Retrospective Cohort Study.

Journal Article Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society · September 2020 PurposeCommunity-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development ... Full text Cite

Real-time Positioning Among Nursing Home Residents Living With Dementia: A Case Study.

Journal Article Wound management & prevention · July 2020 Dementia contributes to the development of pressure injuries (PrIs).PurposeThis study describes the real-time body positions of 2 nursing home (NH) residents, residing in the United States and living with dementia, to inform development of PrI pre ... Cite

Insight Into the Movement Behaviors of Nursing Home Residents Living With Obesity: A Report of Two Cases.

Journal Article Wound management & prevention · May 2020 Obesity (body mass index [BMI] ≥30 kg/m2) can have a profound influence on the likelihood of developing a pressure injury (PrI); little is known about the movement behaviors (movement frequency, body position frequency, and position duration) of obese indi ... Cite

Mitigating the Effects of a Pandemic: Facilitating Improved Nursing Home Care Delivery Through Technology.

Journal Article JMIR aging · May 2020 The coronavirus disease (COVID-19) pandemic has been particularly challenging for nursing home staff and residents. Centers for Medicare & Medicaid Services regulation waivers are burdening staff and affecting how care is delivered. Residents are experienc ... Full text Cite

Evaluation of the Nursing Culture Assessment Tool for Pressure Injury Prevention: A Mixed-methods Study.

Journal Article Wound management & prevention · December 2019 The nursing culture in long-term care (LTC) settings may affect quality measures such as pressure injury (PrI) rates.PurposeThe study was conducted to evaluate the relevance of an LTC facility's nursing culture to both their quality measures and t ... Cite

Influence of Nutrition and Nonnutrition Factors on Pressure Injury Outcomes Among At-Risk Asian Nursing Home Residents.

Journal Article Advances in skin & wound care · October 2019 ObjectiveGiven evidence that malnutrition and immobility increase the risk of pressure injuries (PIs) in nursing home (NH) residents and that body mass index guidelines related to undernutrition may differ between Asian and non-Asian populations, ... Full text Cite

Impact of Cognition and Handfeeding Assistance on Nutritional Intake for Nursing Home Residents.

Journal Article Journal of nutrition in gerontology and geriatrics · July 2019 In nursing homes (NHs), residents are at risk for malnutrition and weight loss. The purpose of this secondary data analysis was to examine the impact of resident cognitive status and level of feeding assistance provided by NH staff on resident's daily nutr ... Full text Cite

Pressure Injury Prevention: Outcomes and Challenges to Use of Resident Monitoring Technology in a Nursing Home.

Journal Article Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society · May 2019 PurposeWe examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in ... Full text Cite

Symptom Distress: Implementation of Palliative Care Guidelines to Improve Pain, Fatigue, and Anxiety in Patients With Advanced Cancer.

Journal Article Clinical journal of oncology nursing · April 2019 BackgroundThe integration of palliative care into standard oncology care is supported by research to improve quality of life and symptom distress in patients with advanced cancer. In 2016, the American Society of Clinical Oncology (ASCO) released ... Full text Cite

Climate and organizational performance in long-term care facilities: The role of affective commitment

Journal Article Journal of Occupational and Organizational Psychology · March 1, 2019 Organizational climate represents the shared perceptions that employees have about their experiences at work. A persistent goal of the literature has been to relate organizational climate to organizational outcomes. Yet, potential mediating mechanisms of t ... Full text Cite

Diffusing an Innovation: Clinician Perceptions of Continuous Predictive Analytics Monitoring in Intensive Care.

Journal Article Applied clinical informatics · March 2019 BackgroundThe purpose of this article is to describe neonatal intensive care unit clinician perceptions of a continuous predictive analytics technology and how those perceptions influenced clinician adoption. Adopting and integrating new technolog ... Full text Cite

Changing Team Member Perceptions by Implementing TeamSTEPPS in an Emergency Department.

Journal Article Journal of emergency nursing · January 2019 IntroductionThe emergency department is an environment where teamwork and communication are of utmost importance and are the foundation for improved patient satisfaction, staff satisfaction, patient safety, and the reduction of clinical errors. An ... Full text Cite

Movement Behaviors of Nursing Home Residents Living With Obesity: A Case Series

Journal Article Wound Management and Prevention · 2019 Cite

Improving the handoff process for certified nursing assistants in an assisted living facility by implementing a handoff tool

Journal Article International Journal of Case Studies in Clinical Research · August 1, 2018 Link to item Cite

Resident Vignettes for Assessing Care Quality in Nursing Homes.

Journal Article J Am Med Dir Assoc · May 2018 OBJECTIVES: Validated process measures that correlate with patient outcomes are needed for research and quality improvement. DESIGN: Cross-sectional analysis within a cluster-randomized fall prevention study. SETTING: Nursing homes in North Carolina (n = 1 ... Full text Link to item Cite

TEAM-UP for quality: a cluster randomized controlled trial protocol focused on preventing pressure ulcers through repositioning frequency and precipitating factors.

Journal Article BMC Geriatr · February 20, 2018 BACKGROUND: Pressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths. PrUs occur most commonly in older adults and NH residence is a risk factor for ... Full text Link to item Cite

Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster-Randomized Trial.

Journal Article JAMA Intern Med · November 1, 2017 IMPORTANCE: New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls. OBJECTIVE: To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality staff interac ... Full text Link to item Cite

Screening Commercial Vehicle Drivers for Obstructive Sleep Apnea: Tools, Barriers, and Recommendations.

Journal Article Workplace health & safety · October 2017 Obstructive sleep apnea (OSA) is a disorder characterized by a cessation of breathing during sleep, leading to poor sleep patterns and daytime somnolence. Daytime somnolence is of particular concern for commercial vehicle drivers, whose crash risk increase ... Full text Cite

Study of Individualization and Bias in Nursing Home Fall Prevention Practices.

Journal Article J Am Geriatr Soc · April 2017 OBJECTIVES: Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether care is affected by implicit bias. DESIGN: Randomized factorial clinical vignette survey. SETTING: Sixteen nursing homes in Nort ... Full text Link to item Cite

Implementation of a Recovery-Oriented Training Program for Psychiatric Nurses in the Inpatient Setting: A Mixed-Methods Hospital Quality Improvement Study.

Journal Article Archives of psychiatric nursing · December 2016 This mixed-methods hospital quality improvement (QI) study primarily aimed to reduce the use of mechanical restraints in a short-stay inpatient psychiatric setting by facilitating change in care delivery through recovery-oriented nursing practice. The impl ... Full text Cite

Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers.

Journal Article Implement Sci · July 16, 2016 BACKGROUND: Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staf ... Full text Link to item Cite

An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care.

Journal Article Journal of nursing care quality · January 2016 Pressure ulcers have consistently resisted prevention efforts in long-term care facilities nationwide. Recent research has described cueing innovations that-when selected according to the assumptions and resources of particular facilities-support best prac ... Full text Cite

Increasing Primary Care Access Close to Home for Residents of Remote Communities in Northern Alberta.

Journal Article Healthcare quarterly (Toronto, Ont.) · January 2016 Residents of Canada's rural and remote communities know the challenges associated with accessing consistent healthcare. Alberta Health Services uses telehealth technology to minimize travel for rural and remote residents who require follow-up with speciali ... Full text Cite

Implementation of an Exercise Program in an Assisted Living Facility.

Journal Article Journal of nursing care quality · October 2015 This quality improvement project was designed to implement a sit-to-stand exercise program delivered by nursing assistants in an assisted living facility. The primary outcome was for residents to either improve or maintain function in activities of daily l ... Full text Cite

Comparison Study of Braden Scale and Time-to-Erythema Measures in Long-term Care.

Journal Article Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society · September 2015 PurposeThe Braden Scale for Predicting Pressure Sore Risk is used to assess risk, and the Centers for Medicare & Medicaid guidelines suggest the use of a tissue tolerance procedure that detects time-to-erythema (TTE) to further refine tissue toler ... Full text Cite

Utility of Braden Scale Nutrition Subscale Ratings as an Indicator of Dietary Intake and Weight Outcomes among Nursing Home Residents at Risk for Pressure Ulcers.

Journal Article Healthcare (Basel, Switzerland) · September 2015 The Braden Scale for Pressure Sore Risk(©) is a screening tool to determine overall risk of pressure ulcer development and estimate severity of specific risk factors for individual residents. Nurses often use the Braden nutrition subscale to screen nursing ... Full text Cite

Using the Nursing Culture Assessment Tool (NCAT) in Long-Term Care: An Update on Psychometrics and Scoring Standardization.

Journal Article Healthcare (Basel, Switzerland) · July 2015 An effective workforce performing within the context of a positive cultural environment is central to a healthcare organization's ability to achieve quality outcomes. The Nursing Culture Assessment Tool (NCAT) provides nurses with a valid and reliable tool ... Full text Cite

Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups.

Journal Article Healthcare (Basel, Switzerland) · July 2014 UnlabelledThe purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movem ... Full text Cite

Nursing culture assessment tool (NCAT): Empirical validation for use in long-term care

Journal Article International Journal of Nursing Sciences · January 1, 2014 Background: Capturing general aspects of the occupational subculture of nursing is needed in long-term care (LTC) given its latent influence on the quality of care that residents receive and on the ability of nursing staff (licensed nurses and certified nu ... Full text Cite

Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study.

Journal Article Journal of the American Geriatrics Society · September 2013 ObjectivesTo test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours.DesignTwe ... Full text Cite

Development and psychometric testing of the nursing culture assessment tool.

Journal Article Clinical nursing research · November 2012 A valid and reliable nursing culture assessment tool aimed at capturing general aspects of nursing culture is needed for use in health care settings to assess and then reshape indicated troubled areas of the nursing culture. This article summarizes the Nur ... Full text Cite

A Nurse-Led Interdisciplinary Leadership Approach Targeting Pressure Ulcer Prevention in Long-term Care.

Journal Article The health care manager · July 2012 Mounting evidence suggests that the quality of outcomes in long-term care can be improved by strengthening the leadership behaviors of nurses. Consequently, a reduction in the prevalence and incidence of pressure ulcers (PUs) is thought to be possible thro ... Full text Cite

A nurse-led approach to preventing pressure ulcers.

Journal Article Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses · May 2011 This article discusses a nurse-led multidisciplinary approach that care providers can use to reduce pressure ulcers (PUs) within their organizations. Given the current understanding of PU etiology and prevention, evidence-based prevention protocols and pre ... Full text Cite

Moving to music

Other · January 12, 2011 Cite

Tailored e-mails in the workplace.

Journal Article AAOHN journal : official journal of the American Association of Occupational Health Nurses · October 2010 Employee wellness programs can potentially contribute to a stronger and healthier work force, with increased dexterity and positive mental health. Programs that keep the work force physically active can reduce heart disease, type 2 diabetes, hypertension, ... Full text Cite

The effect of tailored e-mails in the workplace. Part II. Increasing overall physical activity.

Journal Article AAOHN journal : official journal of the American Association of Occupational Health Nurses · August 2009 The purpose of this study was to evaluate the impact tailored e-mail messages, based on participants' identified needs, have on intentional physical activity. A quasi-experimental design (two groups, repeated measures) in a population of manufacturing work ... Full text Cite

The effect of tailored E-mails in the workplace. Part I. Stage movement toward increased physical activity levels.

Journal Article AAOHN journal : official journal of the American Association of Occupational Health Nurses · July 2009 The purpose of this study was to evaluate the impact tailored e-mail messages, based on participants' identified needs, have on intentional physical activity. A quasi-experimental design (two groups, repeated measures) in a population of manufacturing work ... Full text Cite

The systematic development of a tailored e-mail intervention for health behavior change toward increasing intentional physical activity.

Journal Article Western journal of nursing research · April 2009 Although the benefits of physical activity are well known, most adults in the United States are relatively sedentary, with about 60% of adults not regularly physically active and 25% of those not active at all. This inactivity places the population at risk ... Full text Cite

A summative evaluation of an EMS partnership aimed at reducing ED length of stay.

Journal Article Journal of emergency nursing · January 2009 IntroductionFreestanding emergency departments are full-service emergency departments with no attached inpatient facility. ED congestion and patient dissatisfaction may occur as patients requiring admission are waiting for ambulance arrival and tr ... Full text Cite

Physical activity: the science of health promotion through tailored messages.

Journal Article Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses · March 2008 Sedentary behavior warrants greater attention from rehabilitation nurses because physical fitness plays a role in the success of an individualized rehabilitation program. With one of every two adults being inactive, rates of sedentary lifestyle and obesity ... Full text Cite

Health at every size.

Other AAOHN journal : official journal of the American Association of Occupational Health Nurses · September 2007 Cite

Process of behavioral change as it relates to intentional physical activity.

Journal Article AAOHN journal : official journal of the American Association of Occupational Health Nurses · September 2007 During the past 100 years, America has changed from an agrarian society, where the intent of physical activity was to produce needed materials, to a postindustrial society, where 60% of American adults are not regularly physically active and 25% are not ac ... Full text Cite

Using clinical trial summary results to establish quality measures [4]

Other Journal of the American Medical Association · 2007 Full text Cite