Date of Award

Fall 2024

Project Type

Thesis

College or School

CHHS

Department

Nursing

Departments (Collect)

Department of Nursing

Program or Major

Direct Entry Master's of Nursing

Degree Name

Master of Science

First Advisor

Pamela Kallmerten

Second Advisor

Christina Cebollero

Abstract

Background: The prevalence of pressure injuries (PI) in critical care is highest amongst inpatient units, and are associated with significant complications, decreased quality of life, increased cost of hospitalization, and poor patient care (Agency for Healthcare Research and Quality, 2019; Cox et al., 2022; Gorecki et al., 2014; Mervis & Phillips, 2019). Similarly, many PI are considered to be avoidable (Pittman et al., 2019). Despite an increase in focus on PI awareness and prevention, there still remains a challenge for patients in critical care units. In addition, research has indicated that nurses’ lack of basic knowledge of PI (risk assessment, etiology, prevention, risk factors, and others) may be a contributing factor for their development in at-risk patients. Moreover, research also suggests that multicomponent educational interventions may improve nursing care and practice (Kim et al., 2020; Kitamura et al., 2023 Lin et al., 2019).

Local Problem: An 11-bed intensive care unit (ICU) reported a PI prevalence rate of 8.82%, which was significantly higher than the reported state average of 3.24%. This discrepancy highlights the need to better understand the present knowledge and practices within the microsystem such that targeted interventions can be created to address any gaps in knowledge or practice.

Methods: This quality improvement project (QI) was based on the Define, Measure, Analyze, Improve, and Control (DMAIC) model of QI (American Society for Quality, 2024). After defining the problem, and to understand contributing factors, a baseline assessment of the nursing staff’s attitudes and knowledge was conducted during the Measure phase of the project. A questionnaire was distributed to staff to understand their perceptions and barriers related PI knowledge, prevention, and practices. To assess the staff’s attitudes, the Attitudes Towards Pressure Ulcer Prevention (APuP) instrument was used (Beeckman et al., 2010). To assess the nursing staff’s knowledge, the Pressure Ulcer Assessment Tool 2.0 (PUKAT 2.0) instrument was used (Manderlier et al., 2017). The same surveys were provided to participants pre- and post- intervention to understand whether there was an improvement in attitudes or knowledge.

Interventions: A multicomponent educational intervention consisting of a 20-minute presentation on topics related to PI knowledge and prevention within critical care, and provision of a comprehensive Wound Reference Manual for use as a point-of-care resource.

Results: Pre-intervention survey results revealed a mean APuP score of 81.94 (SD = 5.14, Median = 83, Range = 0-100; N = 16), indicating a positive attitude towards PI prevention. Pre-intervention survey results revealed a mean PUKAT 2.0 score of 46 (SD = 13.47, Median = 50, Range = 0-100; N= 14), indicating decreased knowledge. The mean post-intervention APuP score was 75 (SD = 9.17 , Median = 73, Range = 0-100; N= 3). The score for the single respondent to complete the post-intervention PUKAT 2.0 was 52.

Conclusions: The pre-intervention survey revealed staff have positive attitudes towards PI prevention but lack basic PI and PI prevention knowledge. Due to the decreased post-intervention survey response, it was not possible to determine whether the educational interventions improved nursing attitudes or knowledge. Similarly, PI prevalence data during the project period was not available, and we were unable to determine whether there was a decrease in PI prevalence, following implementation of the interventions. Despite these challenges, there are further opportunities to better understand the impact of educational interventions on nursing knowledge.

Key Words: pressure injuries, nursing knowledge, attitudes, Pressure Ulcer Knowledge Assessment Tool 2.0, Attitudes Towards Pressure Ulcer Prevention, multicomponent educational intervention, nursing resource manual, wound reference manual

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