American Journal of Nursing Research
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American Journal of Nursing Research. 2021, 9(3), 76-84
DOI: 10.12691/ajnr-9-3-2
Open AccessArticle

Pressure Injury Care Program Effects on Nurses’ Performance and Patients’ Pressure Injury Wound Healing Outcomes

Samia Gaballah1, and Dalia Salah El-Deen2

1Medical Surgical Nursing, Faculty of Nursing, Suez Canal University, Egypt.

2Medical Surgical Nursing, Faculty of Nursing, Cairo University & Galala University, Egypt

Pub. Date: March 26, 2021

Cite this paper:
Samia Gaballah and Dalia Salah El-Deen. Pressure Injury Care Program Effects on Nurses’ Performance and Patients’ Pressure Injury Wound Healing Outcomes. American Journal of Nursing Research. 2021; 9(3):76-84. doi: 10.12691/ajnr-9-3-2


Pressure Injury (PI) is a major health problem which imposes a considerable social and economic burden nationally and globally. Aim of the study was to investigate the effect of PI care program on nurse's performance and patients' pressure injury wound healing outcomes. Study design was a quasi-experimental control group using pre-post and follow up design. Sample of thirty nurses and fifty patients were allocated in the current study in two medical units at one of the general hospitals in Ismailia City. Tools: Six tools included nurses' demographic data sheet, pressure injury knowledge questionnaire, and pressure injury care observational checklist, patients' demographic and medical profile data sheet, The Braden Scale, and patients’ pressure injury wound healing outcomes were used to collect data. Results: The study revealed that nurses' knowledge and practices, were significantly improved towards PI care post program implementation when compared to preprogram. Moreover, there was a significant improvement in PI wound healing among patients cared with nurses after receiving the educational program compared with patients who received care before the program. Conclusion: The PI educational program could improve nurses' performance as well as PI wound healing among cared patients. Recommendation: Endorse the educational program for pressure injury care in the nurses' orientation program plus continuous in-service education.

pressure injury care program nursing performance wound healing

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[1]  Ö. G. Kısacık and M. Sönmez, “Pressure ulcers prevention: Turkish nursing students’ knowledge and attitudes and influencing factors,” J. Tissue Viability, vol. 29, no. 1, pp. 24-31, 2020.
[2]  A. D. Lechner et al., “Outcomes for Pressure Ulcer Trials (OUTPUTs) project: review and classification of outcomes reported in pressure ulcer prevention research,” pp. 1-10, 2020.
[3]  W. Care, “Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System Revised Pressure Injury Staging System,” vol. 43, no. December, pp. 585-597, 2016.
[4]  V. Team, C. D. Weller, L. Turnour, A. Jones, and H. Teede, “Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis,” no. October, pp. 370-379, 2019.
[5]  S. Coleman et al., “DISCUSSION PAPER A new pressure ulcer conceptual framework,” 2014.
[6]  A. Hommel, L. Gunningberg, E. Idvall, and C. Bååth, “Successful factors to prevent pressure ulcers - an interview study,” J. Clin. Nurs., vol. 26, no. 1-2, pp. 182-189, Jan. 2017.
[7]  L. Habiballah, “Attitudes of intensive care nurses towards pressure ulcer prevention,” vol. 6, no. 3, pp. 2-8, 2018.
[8]  V. Simonetti, D. Comparcini, M. E. Flacco, P. Di Giovanni, and G. Cicolini, “Nursing students’ knowledge and attitude on pressure ulcer prevention evidence-based guidelines: a multicenter cross-sectional study,” Nurse Educ. Today, vol. 35, no. 4, pp. 573-579.
[9]  S. Dalvand, A. Ebadi, and R. G. Gheshlagh, “Nurses’ knowledge on pressure injury prevention: A systematic review and meta-analysis based on the pressure ulcer knowledge assessment tool,” Clin. Cosmet. Investig. Dermatol., vol. 11, pp. 613-620, 2018.
[10]  F. Coyer et al., “Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE),” Am. J. Crit. Care, vol. 24, no. 3, pp. 199-209, 2015.
[11]  M. Y. N. Saleh, P. Papanikolaou, O. S. Nassar, A. Shahin, and D. Anthony, “Nurses’ knowledge and practice of pressure ulcer prevention and treatment: An observational study,” J. Tissue Viability, vol. 28, no. 4, pp. 210-217, 2019.
[12]  F. E. Ursavaş and Ö. İşeri, “Effects of education about prevention of pressure ulcer on knowledge and attitudes of nursing students,” J. Tissue Viability, vol. 29, no. 4, pp. 331-336, 2020.
[13]  P. Özyürek, M. Yavuz, and Ö. Yıldız, “Investigation of the risk factors of pressure ulcers in intensive care unit patients: According to the Braden scale,” East. J. Med., vol. 21, no. 1, pp. 1-9, 2016.
[14]  A. Al Mutairi and A. Al Mutair, “Hospital-acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow-up program in Saudi Arabia,” no. June, pp. 1135-1141, 2020.
[15]  A. Al Mutair, Z. Ambani, F. Al Obaidan, K. Al Salman, H. Alhassan, and A. Al Mutairi, “The effectiveness of pressure ulcer prevention programme: A comparative study,” Int. Wound J., vol. 17, no. 1, pp. 214-219, 2020.
[16]  J. Morel et al., “Risk factors of pelvic pressure ulcer recurrence after primary skin flap surgery in people with spinal cord injury,” Ann. Phys. Rehabil. Med., vol. 62, no. 2, pp. 77-83, 2019.
[17]  S. Gaspar de Matos, M. Collier, A. Marques, C. Ferreira, and M. G. de Matos, “Pressure ulcers: The challenge of monitoring in hospital context,” Appl. Nurs. Res., vol. 53, no. November 2019, p. 151266, 2020.
[18]  A. van Dishoeck, C. W. N. Looman, E. W. Steyerberg, R. J. G. Halfens, and J. P. Mackenbach, “Performance indicators; the association between the quality of preventive care and the prevalence of hospital‐acquired skin lesions in adult hospital patients,” J. Adv. Nurs., vol. 72, no. 11, pp. 2818-2830, 2016.
[20]  J. Charan and T. Biswas, “How to calculate sample size for different study designs in medical research?,” Indian J. Psychol. Med., vol. 35, no. 2, pp. 121-126, Apr. 2013.
[21]  F. Elmansy, A. Shebl, N. Taha, and M. Ibrahim, “Effect of Pressure ulcer Guidelines on Nurses’ Performance and Patients’ Outcomes,” 2018.
[22]  J. Kottner, R. Halfens, and T. Dassen, “An interrater reliability study of the assessment of pressure ulcer risk using the Braden scale and the classification of pressure ulcers in a home care setting,” Int. J. Nurs. Stud., vol. 46, no. 10, pp. 1307-1312, Oct. 2009.
[23]  National Pressure Ulcer Advisory Panel, “Pressure Ulcer Scale for Healing (PUSH) PUSH Tool 3.0,” PUSH Tool, vol. 3.0, pp. 0-1, 2998.
[24]  National Pressure Ulcer Advisory Panel (U.S.), Prevention and treatment of pressure ulcers: clinical practice guideline: international guideline. 2019.
[25]  National Pressure Ulcer Advisory Panel European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. 2014.
[26]  M. Park, G. Kim, and K. Kim, “The Effect of Pressure Injury Training for Nurses: A Systematic Review and Meta-analysis,” Adv. Ski. Wound Care, vol. 33, no. 3, pp. 1-11, 2020.
[27]  B. Delmore, E. A. Ayello, H. Smart, and R. G. Sibbald, “Assessing Pressure Injury Knowledge Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test.,” Adv. Skin Wound Care, vol. 31, no. 9, pp. 406-412, Sep. 2018.
[28]  S. A. Mohamed and S. M. Weheida, “Effects of implementing educational program about pressure ulcer control on nurses’ knowledge and safety of immobilized patients,” J. Nurs. Educ. Pract., vol. 5, no. 3, 2014.
[29]  I. Köse and G. Öztunç, “Knowledge of Nurses Working in Intensive Care Units in Relation to Preventive Interventions for Pressure Ulcer,” Int. J. Caring Sci., vol. 9, no. 2, p. 677, 2016.
[30]  T. Sengul and A. Karadag, “Determination of nurses’ level of knowledge on the prevention of pressure ulcers: The case of Turkey,” J. Tissue Viability, no. May, pp. 7-11, 2020.
[31]  F. Coyer, J. L. Cook, A. Doubrovsky, J. Campbell, A. Vann, and G. McNamara, “Understanding contextual barriers and enablers to pressure injury prevention practice in an Australian intensive care unit: An exploratory study,” Aust. Crit. Care, vol. 32, no. 2, pp. 122-130, 2019.
[32]  J. Y. Kim and Y. J. Lee, “A study on the nursing knowledge , attitude , and performance towards pressure ulcer prevention among nurses in Korea long- term care facilities,” no. September 2018, pp. 29-35, 2019.
[33]  D. De Meyer, S. Verhaeghe, A. Van Hecke, and D. Beeckman, “Knowledge of nurses and nursing assistants about pressure ulcer prevention: A survey in 16 Belgian hospitals using the PUKAT 2.0 tool,” J. Tissue Viability, vol. 28, no. 2, pp. 59-69, 2019.
[34]  H. Rafiei, H. Mehralian, M. E. Abdar, and T. Madadkar, “Pressure ulcers: how much do nursing students really know?,” Br. J. Nurs., vol. 24, no. 6, pp. S12, S14-7, Mar. 2015.
[35]  P. Fulbrook, P. Lawrence, and S. Miles, “Australian Nurses’ Knowledge of Pressure Injury Prevention and Management: A Cross-sectional Survey,” J. Wound, Ostomy Cont. Nurs., vol. 46, no. 2, pp. 106-112, 2019.
[36]  I. Mwebaza, G. Katende, S. Groves, and J. Nankumbi, “Nurses’ Knowledge, Practices, and Barriers in Care of Patients with Pressure Ulcers in a Ugandan Teaching Hospital,” Nurs. Res. Pract., vol. 2014, pp. 1-6, 2014.
[37]  S. Nasreen, M. Afzal, and H. Sarwar, “Nurses Knowledge and Practices toward Pressure Ulcer Prevention In General Hospital Lahore,” pp. 520-527.
[38]  S. Khojastehfar, T. Najafi Ghezeljeh, and S. Haghani, “Factors related to knowledge, attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study,” J. Tissue Viability, vol. 29, no. 2, pp. 76-81, 2020.
[39]  E. W. K. Rn, F. Associate, L. Y. C. Rn, A. Rick, Y. K. Rn, and P. H. Lee, “The effectiveness of a pressure injury prevention program for nursing assistants in private for-profit nursing homes: A cluster randomized controlled trial,” no. August 2019, pp. 1780-1793, 2020.
[40]  A. M. Cogan, J. Blanchard, S. L. Garber, C. L. P. Vigen, M. Carlson, and F. A. Clark, “Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury,” Clin. Rehabil., vol. 31, no. 7, pp. 871-880, 2017.
[41]  M. T. S. Kula and R. I. P. GaPUD, “Prevalence and risk factor assessments of pressure ulcers among medical in‐patients in ripas hospital,” Brunei Int. Med. J., vol. 14, pp. 151-156, 2018.
[42]  M. Lotfi, A. M. Aghazadeh, H. Asgarpour, and A. Nobakht, “Iranian nurses’ knowledge, attitude and behaviour on skin care, prevention and management of pressure injury: A descriptive cross-sectional study,” Nurs. Open, vol. 6, no. 4, pp. 1600-1605, 2019.
[43]  Y. Amir, C. Lohrmann, R. J. G. Halfens, and J. M. G. A. Schols, “Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment,” Int. Wound J., vol. 14, no. 1, pp. 184-193, 2017.
[44]  H. Koyanagi, A. Kitamura, G. Nakagami, K. Kashiwabara, H. Sanada, and J. Sugama, “Local wound management factors related to biofilm reduction in the pressure ulcer: A prospective observational study,” Japan J. Nurs. Sci., no. September, pp. 1-8, 2020.
[45]  A. Stern et al., “Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care,” pp. 1-13, 2014.