Pressure Injury Prevention Research Articles

Is YouTube a Useful Source of Information on Pressure Injuries? A Content, Reliability, and Quality Analysis.

To evaluate the comprehensiveness, reliability, and quality of YouTube videos related to pressure injuries. The authors searched YouTube for relevant videos using the keywords "pressure injury", "pressure ulcer", "bedsore", "pressure injury etiology", "pressure injury classification", "pressure injury prevention", "pressure injury risk assessment", and "pressure injury management". Of the 1,023 videos screened, 269 met the inclusion criteria and were included in the study. For each video, the authors recorded the number of views, likes, and comments; the length; and the video upload source. The Comprehensiveness Assessment Tool for Pressure Injuries, the Quality Criteria for Consumer Health Information score, and the Global Quality Score were used to evaluate the comprehensiveness, reliability, and quality of the videos. The mean length of the 269 videos was 6.22 ± 4.62 minutes (range, 0.18-19.47 minutes). Only 14.5% of the videos (n = 39) were uploaded by universities or professional organizations. Most videos included information about PI prevention (69.5%), followed by PI management (27.9%). The mean comprehensiveness score was 2.33 ± 1.32 (range, 1-5). Nearly half of the videos (49.1%) were not reliable. However, the quality of 43.9% of the videos was somewhat useful. The Quality Criteria for Consumer Health Information mean scores of universities/professional organizations (P < .001), nonprofit healthcare professionals (P = .015), and independent health information channel videos (P = .026) were higher than the mean score of medical advertising/profit companies channel videos. This study draws attention to the need for more comprehensive, high-quality, and reliable videos about PIs. It is important that videos on YouTube provide comprehensive and reliable information for patients, caregivers, students, or providers seeking information on PI prevention, assessment, and management.

Student nurses' knowledge levels and attitudes regarding pressure injury prevention

ObjectiveThe research was conducted to examine the relationship between student nurses' knowledge levels and attitudes regarding pressure ulcer prevention. MethodThe research was registered between 01.05.2022 and 01.12.2022, and the certification studies of the health sciences faculty of a state and a foundation university in Turkey are carried out on a multi-center basis. The lists of the research were created by 426 student pictures. "Nurse Introduction Form", "Pressure Sore Prevention Information Survey" and "Attitude Scale towards Preventing Pressure Ulcers" were used as data collection tools. Data was collected online via Google Forms and the SPPS 24.0 program was evaluated in detail. ResultsIt was determined that the PIPK total score of Student Certificates was 18.29 ± 5.98, and the total score of APUP was 33.96 + 4.66. The change analysis results revealed positive aspects and a low-level significant relationship between the average nutrition total knowledge scores and the pressure prevention attitude total scores (p < 0.05). ConclusionIn our study results, it was determined that the pressure values of the certificates and the knowledge scores of the students were insufficient and the attitudes were positive. The values of knowledge and attitudes regarding the nurturing of the values of certificates, starting from student life, states where the necessary knowledge and skills must be acquired in educational programs.

Movement and Pressure Injury Prevention Care for Nursing Home Residents: Addressing the Nescience.

To compare movement associated with position changes among nursing home residents who remain in lying versus upright positions for more than 2 hours and among residents living with obesity, dementia, or neither condition. The authors conducted a descriptive exploratory study using secondary data (N = 934) from the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) clinical trial to examine transient movements (<60 seconds) within prolonged periods of 2 to 5 hours without repositioning. Nursing home residents exhibit significantly more episodic transient movements when upright than lying. Residents with obesity or dementia exhibited similar frequencies of episodic transient movements compared with residents with neither obesity nor dementia. Upright or lying movements were more frequent among residents with obesity than among those with neither obesity nor dementia selectively when prolonged events ranged from 2 to 4 hours. Pairwise comparisons of movement rates among resident subgroups (living with obesity, living with dementia, or neither group) across repositioning intervals showed episodic transient movements were significantly higher across all subgroups for repositioning intervals up to 3 hours when compared with repositioning intervals of greater than 3 hours. Findings challenge assumptions that nursing home residents are inactive and at risk for prolonged sitting. These preliminary findings, along with TEAM-UP findings where no pressure injuries occurred in up to 5 hours in prolonged positions, support establishing a standard 3-hour repositioning interval with use of high-density mattresses without a negative impact on pressure injury occurrence. There should be caution when considering repositioning intervals greater than 3 hours. Further research is indicated to explore protective effect of episodic transient movements of other subgroups.

A CROSS-SECTIONAL ANALYSIS OF KNOWLEDGE AND ATTITUDES OF NURSES TOWARDS THE PREVENTION OF PRESSURE INJURIES

Pressure injuries (PIs) are a significant concern in healthcare settings, often leading to severe complications for patients. Effective prevention relies heavily on the knowledge and attitudes of nursing staff. Understanding these factors can help formulate strategies to improve patient care and outcomes. Objective: To evaluate the knowledge and attitudes of nurses toward preventing pressure injuries and identify the factors influencing these parameters. Methods: A cross-sectional study was conducted in the Nursing Department of a Tertiary Care Hospital from May 2023 to May 2024. A total of 300 nurses working in the hospital for more than a year and without supervisory roles were selected using consecutive sampling. Data were collected through an anonymous questionnaire divided into demographic information, knowledge assessment using Pieper’s Pressure Ulcer Knowledge Test, and attitudes evaluation using the Attitude Towards Pressure Ulcer Prevention Instrument. Statistical analysis was performed using descriptive statistics and appropriate tests to assess the relationships between variables. Results: The average knowledge score among nurses was 32.88 ± 2.49, with a score of 6.10 ± 1.12 for PI evaluation and 26.83 ± 2.20 for prevention and grading. 59% of participants demonstrated good knowledge. The average attitude score was 39.90 ± 3.81, with the highest score in the personal role subgroup (7.91 ± 0.99) and the lowest in personal efficacy (9.84 ± 1.09). 54% of participants exhibited a favourable attitude towards PI prevention. Conclusion: Nurses displayed satisfactory knowledge and attitudes toward preventing pressure injuries. Enhancing these parameters through exemplary leadership, quality education, and regular training programs can improve healthcare outcomes and patient safety.

The Effectiveness of Mobile Applications in Improving Nursing Students' Knowledge Related to Pressure Injury Prevention.

The study's main goal was to compare the effects of a mobile application versus traditional methods of teaching on nursing students' acquisition of knowledge about pressure injury prevention. In addition, a secondary aim was to discover nursing students' viewpoints related to the advantages and disadvantages of using mobile applications as an educational method. A randomized controlled study design was implemented during November and December of 2023 in a nursing faculty with 60 undergraduate students in their second nursing year. A total of 30 students were assigned to the mobile application group, while the other 30 students were assigned to the traditional lecture group. The study was executed in three stages: pre-test, educational intervention, and post-test. The results of the study during the pre-test showed that there were no statistically significant differences in the mean scores of pressure injury themes between the two groups. However, the post-test scores for all PI themes were higher in the mobile application group compared to the traditional lecture group. Furthermore, five advantages of the mobile application were highlighted by students: "improvement of students' knowledge and skills", "self-confidence", "stress reduction", "enhancement of competence", and "stimulation of learning motivation". This study demonstrated the effectiveness of the mobile application method in enhancing nursing students' knowledge and prophylaxis of pressure injury. Therefore, the mobile application method is recommended as an innovative approach to teaching.

Knowledge and attitudes regarding pressure injuries among assistant nurses in a clinical context.

This study aimed to evaluate assistant nurses' knowledge of and attitudes towards pressure injuries in a clinical setting. It employed a cross-sectional design, using two validated surveys: PUKAT 2.0 and APUP, alongside open-ended questions. A convenience sample of 88 assistant nurses from five wards across two departments at a 600-bed university hospital in Sweden participated. Participants answered the questionnaire and open-ended questions, followed by a learning seminar led by the study leader covering PUKAT 2.0 knowledge questions. The seminar ended with an evaluation of this training approach. Results revealed a significant knowledge gap in pressure injury prevention among assistant nurses, with a mean PUKAT 2.0 knowledge score of 33.8 and a standard deviation of ±11.7 (a score of 60 is deemed satisfactory). Only 3.4% (n = 3) of participants achieved a satisfactory knowledge score. However, attitudes towards pressure injury prevention, assessed by the APUP tool, were generally positive among the majority of the participants. Open-ended questions and evaluations of the seminar showed assistant nurses' desire for pressure injury prevention training and their appreciation for the seminar format. Further studies need to evaluate recurrent training procedures and departmental strategies aimed at reducing the knowledge gap among healthcare staff.

Prophylactic dressings to prevent sacral pressure injuries in adult patients admitted to intensive care units: A three-arm feasibility randomized controlled trial

BackgroundPressure injuries in intensive care patients are a safety issue. Specialized foam sacral prophylactic dressings prevent pressure injuries with several products available for clinicians to choose from. ObjectivesAssess the feasibility of conducting a multisite trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients. MethodsUsing a three-arm pilot randomized trial design, adult intensive care unit patients at risk for pressure injuries were randomly allocated to the Mepilex® Sacrum dressing, the Allevyn™ Life Sacrum dressing or the control group. Daily pressure injury data were collected including a de-identified sacral photograph, which the blinded outcome assessor used to determine the study end point: a new sacral pressure injury. Pre-determined feasibility criteria were measured in terms of eligibility, recruitment, retention, intervention fidelity and missing data. ResultsFrom May-September 2021, we screened 602 intensive care unit adult patients for eligibility with 93 % (n = 558) excluded. Forty-four (7 %) were eligible, and all were recruited and randomized (100 %). After receipt of the intervention two participants withdrew from the study. Our final sample of 42 participants were randomly allocated to the Mepilex® (n = 12), Allevyn™ (n = 14) or control (n = 16) group. The interventions were delivered as intended and there were 11 (6 %) cases of missing outcome data. Five participants (12 %) developed a sacral pressure injury, four of whom received a sacral dressing. ConclusionsA larger trial is feasible with minor refinement to the length of stay eligibility criterion. Implications for practiceProphylactic sacral dressings are recommended for pressure injury prevention. Determining the feasibility of a larger trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients can provide evidence to aid clinicians, policy makers and managers make value-based care decisions.

Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review

BackgroundA pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients.MethodsThe literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines.ResultsTwelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1–96.7% before intervention to 0.3–53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates.ConclusionsIn the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness.Trial registrationThe review protocol was registered (PROSPERO registration number: CRD42022346450).

On the Move pad – a portable multipurpose pad: User feedback

Context/Objective Hard-shell toilet seats may compromise safety and hinder the participation of individuals at risk for pressure injuries (PIs) when using these facilities away from home in public, hotel, or family/friend restrooms. Moreover, people often add “wash-cloths” for additional padding for comfort, and to reduce the risk of PIs due to pressure or shearing on their wheelchairs surfaces. This study investigated the utilization of portable pads, initially designed for toilet use but adaptable to various places and contexts, while examining pad usability. Design A cross-sectional descriptive survey design. Setting Inpatient care, outpatient care, and community setting. Participants 45 individuals at risk of PIs. Results Participants extended the use of these pads beyond toilets, employing them as wheelchair armrest and leg rest pads in other settings. Feedback from a customized questionnaire indicated high levels of usefulness (8.5/10) and ease of use (9.1/10) attributed to the pads. Among the features, the top three favored were ease of use, comfort/cushioning, and function. Participants expressed a desire for a variety of sizes and colors to enable versatile usage and suggested incorporating a pocket for storing small items. Conclusions and Relevance Individuals at risk of PIs require cushioning not only on hard-shell toilet seats, but also for additional padding, protection and enhancing the use of wheelchairs. Rehabilitation professionals can play a crucial role in educating and training both clients and caregivers to understand PI prevention, enabling them to effectively leverage the pads in appropriate situations, thereby enhancing their comfort in their wheelchairs during social engagement.

Effectiveness of an online educational intervention for pressure injury prevention in caregivers: a pre-test post-test study

Effectiveness of an online educational intervention for pressure injury prevention in caregivers: a pre-test post-test study

Associations between body mass index and interface pressure after 3 h loading in healthy adults

Aim of the studyThe purpose of this study was to determine the associations between body mass index and interface pressure after 3 h loading in healthy adults and to establish a foundation for the development of interventions tailored to body mass index. Material and methodsA secondary data analysis based on a clinical trial involving 75 adults was conducted. Data were analyzed using descriptive statistics, repeated measure ANOVA, and ANCOVA. The statistics program IBM SPSS Statistics 27.0 was used for data analysis. ResultsLoading caused a significant increase in average pressure in the obesity group compared to the underweight group. There was a significant increase in risk area ratio calculated based on 30 mmHg and 45 mmHg in both obesity and overweight groups compared to the underweight group. On both support surfaces, average pressure, peak pressure, and risk area ratio were higher in the obese group compared to the normal weight group. However, these differences were not statistically significant. ConclusionGiven the emphasized risk of pressure injuries, long-term observation of body mass index-specific changes in interface pressure can provide crucial evidence for pressure injury prevention nursing. The results of this study suggest the need to implement pressure injury prevention interventions that consider the pressure characteristics according to BMI.

Application of bundled process control in the prevention of pressure injury in patients with head and neck cancer.

This study aimed to explore the application effects of cluster process control and routine nursing on the prevention of pressure injury (PI) in patients undergoing head and neck cancer surgery and to provide a basis for reducing the occurrence of PI, thereby promoting the safety of the patients. This was a retrospective study. Patients with head and neck cancers who underwent surgical treatment in the Department of Otolaryngology at the Second Affiliated Hospital of Fujian Medical University from July 2022 to June 2023 were selected as the research participants. Participants were classified into experimental and control groups using a convenience sampling method. In the experimental group, cluster process control was implemented, while routine nursing management was applied in the control group. The incidence of PI (p = 0.028) and healing time (p = 0.035) in the experimental group were lower than those in the control group. The process management ability of nurses in the experimental group was significantly improved, with the results for the Braden scale (p = 0.023), effective decompression (p = 0.002), floating heel (p = 0.002), nutrition monitoring (p = 0.005), and patient satisfaction in the experimental group being higher than those in the control group (p = 0.007). This study effectively demonstrated the effect of cluster process control in reducing the incidence of PI in patients undergoing head and neck cancer surgery, thereby determining that cluster process control is suitable for clinical application.

Knowledge and practice of informal caregivers on pressure injury prevention and treatment among patients receiving palliative care.

Pressure injuries (PIs) are prevalent in palliative care. Lack of knowledge and skills among informal caregivers on PI prevention and management contributes significantly to the occurance or deterioration of PIs. The aims of this study were to: (1) determine the level of knowledge and practices of informal caregivers on PI prevention and treatment; (2) explore the socio-demographic characteristics of informal caregivers that influence PI prevention and treatment among patients who need palliative care. The quantitative cross-sectional descriptive design was used to collect data from 146 informal caregivers, and a valid and reliable questionnaire was used. A total of 146 informal caregivers of patients with PI completed the study. Most participants had a relatively low level of PI prevention, treatment knowledge and practice. Participants who were older than 28 years, working for the government and married had significantly better knowledge and practice of PI prevention and treatment than other participants. Information for informal caregivers in different settings about PI prevention and treatment is needed. Informal caregivers need to acquire more professional practices and knowledge to improve the quality of patient care.

Determination of the family caregivers’level of knowledge on pressure injury prevention

ObjectiveThe purpose of this study is to determine family caregivers’ level of knowledge on pressure injury (PI) prevention. MethodsThis study used a cross-sectional and descriptive design. Data were collected between February and May 2023. The population of the study consisted of family caregivers providing care to patients who were at risk of developing pressure injuries and who were planned to be discharged from the inpatient wards of the hospital. A total of 105 family caregivers participated in the study. ResultsOf all the patients, 61.9 % (n = 65) were female and their average age was 68.96 years (SD = 18.07). While 30.48 % (n = 32) of the patients were bedridden due to Cerebrovascular Accident, 28.57 % (n = 30) were bedridden due to old age, and 28.57 % (n = 30) had PI. Of all the caregivers, 71.43 % (n = 75) were female, and their average age was 47.11 years (SD = 14.85). While 97.14 % (n = 96) of the caregivers had not received any training on PI before, 90.48 % (n = 95) had not provided care to a patient with PI before. Family caregivers scored an average of 22.25 (SD = 6.96) points out of 40 on the Pressure Injury Prevention Knowledge Test (PIPKT). A significant difference was detected between the knowledge test scores and education level and income level (P = 0.006; P = 0.002). ConclusionsFamily caregivers were found to need information about PI prevention. It is recommended to develop content on PI prevention in the guidelines for family caregivers.

The effect of support surface on the prevention of pressure injury in acute care settings: A multi-center prospective observational study

PurposeThis study aimed to analyze if a multi-foam core mattress with a laminated cover can reduce the incidence of pressure injuries, compared to an alternating air mattress overlay among critically ill patients in acute settings. DesignProspective observational study. Participantsand setting: Patients with a Braden scale score ≤16 on intensive care unit admission at five general hospitals in Korea were included in this study between February 2022 and March 2022. MethodsOne hundred and twenty patients in acute settings were enrolled and categorized into two groups: a multi-form core mattress with a laminated cover group (n = 60) and an alternating air mattress overlay group (n = 60). Data were collected for 7 days by wound care nurses. ResultsPressure injury developed at a significantly lower rate in the multi-form core mattress with a laminated cover group (n = 4/60, 6.7 %) than in the alternating air mattress overlay group (n = 25/60, 25.0 %) (P = 0.011). Using a multi-foam core mattress with a laminated cover demonstrated a protective effect against pressure injuries (odds ratio 0.123, 95 % confidence interval 0.024–0.620, P = 0.011). ConclusionsA multi-foam core mattress with a laminated cover was significantly more effective than an alternating air mattress overlay in preventing pressure injury in critically ill patients.

Polyrethane Foams Combined with Vaseline Prevents 1st Degree Pressure Injuries in Neurosurgical Surgery Patients: Literature Review

Introduction: In the world of healthcare, the prevention of pressure injuries in neurosurgical patients in the operating room is an important aspect to prevent serious complications, such as infection and impaired circulation. Grade 1 pressure injuries, although often considered minor, can have a serious impact on patients' recovery and quality of life. Therefore, effective prevention strategies are urgently needed. Objective: This literature review aims to evaluate the use of Polyurethane Foams combined with Vaseline as a method of preventing 1st degree pressure injuries in neurosurgical patients in the operating room. Methods: The method of writing this literature review article uses a narrative review approach. The data used is secondary data obtained from several databases such as Google Schoolar, PubMed, Science Direct, and Research Gate. The literature search in the preparation of the article uses a period of publication years ranging from 2016 to 2024. Results: Preliminary results show that this combination can significantly reduce the risk of 1st degree pressure injuries. Conclusion: Polyurethane Foams and Vaseline were selected based on their specific properties which were considered to support healing and provide protection. The Munro Scale measurement tool was used as a reference for interventions carried out in moderate and high-risk patients.

Effect of Pressure Injury Prevention Training Program on Caregiver's Knowledge, Attitude, and Practices in Selected Geriatric Care Homes

Effect of Pressure Injury Prevention Training Program on Caregiver's Knowledge, Attitude, and Practices in Selected Geriatric Care Homes

Comparing the effectiveness of active and reactive mattresses in pressure injury healing: a pilot study.

A feasibility study to test the proposed methodology for a larger randomised control trial was conducted, investigating the comparative effectiveness of the two types of pressure management support surfaces with regards to healing pressure injuries (PI). A secondary objective was to provide insights into the user acceptability of the two types of pressure management support surfaces. A randomised control feasibility study was conducted in a community health setting in Canberra, Australia. Patients aged ≥65 years with an existing Stage 2 PI who slept in a bed were eligible. Participants were randomised to either the active mattress group or the reactive mattress group for use on their bed. All participants received standard wound care by community nursing staff and were provided an air-flotation cushion for use when not in bed. Photographs were taken and used for blind assessment of wound healing. Secondary information was gathered through a survey regarding user acceptability of the support surfaces and changes in habits regarding PI prevention strategies. In total, five patients were recruited, with one passing away prior to mattress allocation. Results were inconclusive with regards to comparative effectiveness and user acceptability due to the small sample size; however, secondary data indicated an increasing implementation of PI prevention strategies. This study confirmed the need for further high quality research comparing reactive and active pressure mattresses. Trends indicate the importance of including education on PI prevention strategies to promote changes in behaviour. Changes to the proposed methodology will be made to increase recruitment in the primary study.

2024 Conference Poster Collection: Positioning and Pressure Injury Prevention.

2024 Conference Poster Collection: Positioning and Pressure Injury Prevention.

Pressure Injury Prevention in Adult Critically Ill Patients: A Best Practice Implementation Project.

Implementation science is the process of integrating an intervention into practice within an organization or health system and is a useful strategy to improve practice, affect patient outcomes, and promote practice sustainability. In this series, AJN and the journal JBI Evidence Implementation have partnered to deliver examples of how health care facilities from around the world have worked to solve common patient care problems. Through this partnership, we strive to create awareness and share knowledge and experiences by publishing summaries of studies that have appeared in JBI Evidence Implementation. These summaries are designed to provide nursing teams with an overview of the barriers faced and the strategies and resources needed to improve practice and drive change at the unit level. Our goal is to ensure that AJN readers have access to important evidence-based information designed to influence patient outcomes and nursing practice.-Carl A. Kirton, DNP, MBA, RN, ANP, FAAN.