Section 1: Nature of the Project

 

Introduction

Pressure Injuries, also known as Pressure Ulcers, have presented issues in long-term care facilities and have occasionally influenced a person’s quality of life. According to Vasconcelos and Caliri (2015, p. 1), “A pressure injury is a solemn challenge, and it has hostile influences on health care by impacting the patient’s wellness.” Various risk aspects affect the life quality and the continuous impacts of long-term care residents with pressure injuries. Studies illustrate that additional education and training programs are necessary for nurses managing pressure injuries in long-term care facilities (Mallah et al., 2015). This project illustrates the need for additional education for the nurses in a Long-Term Care facility. Changing evaluation and treatment practices assist in enhancing quality of life and decreasing health decline resulting from pressure injuries. Pressure injury (PI) incidence density is regarded as a high-quality measure concerning pressure injury prevention. This measure is computed as the number of patients enrolled in a care facility who obtained a pressure injury. Pressure injuries could be deadly, especially among immobile and elderly patients. Pre-emptive actions to assess and treat pressure injuries are essential to influence the healing results (Jaul & Menzel, 2014). Nurses are the principal links in charge of treating, assessing, and healing the PI, beginning with admission. An unattended PI may cause skin injuries among patients, and the increased workload would increase the use of unique resources and nursing hours. There is an association between care quality and recruitment setting, work fulfillment, and exhaustion, according to Koy et al. (2015). PI’s healing and treatment difficulties are challenging for the nurses in this process, influencing the care quality outcomes. Managing PI can be an issue in treating and healing them (Han & Ceilley, 2017). Therefore, this project will confidently discuss these issues, hoping to influence the quality-of-care outcomes directly. This project aligns with Walden’s mission to use scholarly approaches to promote positive social changes in scholarly practice.

Problem Statement

Pressure injuries are an issue among patients in long-term care facilities. According to the Centers for Disease Control (CDC; 2020), 11% of the nursing home population had PI linked to other additional diagnoses referred to as comorbidities. Nurses singled out the best practices that can help prevent or decrease PI. The leading practice included improved education to promote the quality of life. According to Kayser et al. (2018), pressure injuries in the care facility are avoidable incidents. In specific scenarios, the nurses used expensive wound-curing treatments for patients referred to wound care facilities (Son et al., 2019). Nursing facility managers should report PI to the supervisory bodies (Nkala, 2015). According to Allen et al. (2017), the sentinel measures are an unanticipated incidence necessitating instantaneous consideration, which might result in physical damage or even death. This project addresses the training and education of the nurses concerning the treatment and healing of the PI in the care facility, the pressure it places on nurses, and the impact it presents. The number of PIs discussed in staff meetings and the topic of numerous sentinel events reported at the facility revealed an increase of 2000% over the past 6 months. This staff education project will address the training and education of nurses to reduce the amount of PI’s. Studies have indicated that additional examination is needed to determine if extra training and education for the elderly public decreases strain among nurses (Singh et al., 2014). The link between the PI and career-related pressure injuries significantly impacts nurses (Anderson et al., 2014). The nursing staff’s admission and evaluation procedure of PI patients is vital from an educational perspective for long-term care facility nurses. The nurses should be educated to administer treatment, initiate assessment procedures, and heal PI patients while enhancing their quality of life.

This doctoral project intends to advance the effects of education on pressure injury prevention in a long-term care facility by addressing the local nursing practice issues of insufficient understanding resulting in avoidable PIs. Addressing PI prevention using education in a local long-term care facility is vital. Information and documentation highlight the direct implications on patient wellness. This doctoral project is significant for nursing practice since it identifies areas to improve nursing practice, patient care, and add vital understanding to the nurse in general, thus enhancing efficiency and service delivery.

Purpose Statement

The fundamental purpose of this doctoral project will examine how education on PI among nurses could influence their capacity to prevent pressure injuries in a Long-Term Care Facility. Various Registered Nurses (RNs) in a long-term care facility, such as nursing staff and managers/supervisors, will be interviewed to examine the aspects that would help decrease stress among the nurses and enhance the quality of care. The findings of this project will affect the results of the administrative agencies who evaluate the care facilities by examining the watch measures using the Online Survey, Certification, and Reporting System Report (OSCAR). This project will fill a significant gap by examining and addressing the deficiency of wide-ranging education in a long-term care facility for the nurses, targeting to enhance PI prevention measures for improved patient wellness suggestively. The practice-focused question for this project will determine how effective an educational program for nursing staff on pressure injury could increase their knowledge and translate the knowledge learned in the educational program into practice to prevent pressure injuries. This project could address the practice gap by methodically analyzing educational effects on PI prevention and management in long-term care facilities. The project will use evidence-based education to identify best practices for educational and training approaches, thus offering actionable understanding to fill the prevailing gap in nursing practice.

Nature of the Doctoral Project

The evidence used to meet this doctoral project’s purpose includes information obtained from various literature searches from the Cumulative Index of Nursing and Allied Health (CINAHL), Medline, and Cochrane Library. The population involved in this project includes long-term care nurses, the wound care RN of refer facility to measure knowledge on PIs. The doctoral project will obtain knowledge of an EBP for PI prevention and management in a long-term care facility. A questionnaire will assess nurses’ knowledge of PI prevention. The staff education project will include a pretest given to all participants. An educational session will be provided.  A posttest questionnaire which will be the same questions as the pre-test will be given to all the participants. The results will be analyzed using Excel and a paired sample t test to determine the effect of the provided education on nursing knowledge on PI.

Significance

Stakeholders such as patients, nurses, and managers will benefit from enhanced PI prevention through boosted education, thereby encouraging improved medical results and resource use. The doctoral project will enhance nursing practices using evidence-based educational approaches, improving PI prevention in the long-term care facility. The findings from this project will offer insight into PI prevention education in the long-term care facility, thus improving transferability for more comprehensive nursing practice. This will enable long-term care nurses to use efficient education, resulting in reduced PIs, thus promoting positive social changes in the long-term care facility.

This doctoral project, therefore, addresses the necessity for additional education on PI prevention, particularly from the adverse insights of healthcare connected with PI. This project will educate nurses to prevent PI in long-term care facilities. Improving the educational programs for the nurses will increase their knowledge in preventing PI.

Summary

Pressure injuries can be avoidable and failure to do so could result in grave problems if they are not recognized and treated promptly. Persons who stay motionless for a prolonged period or perhaps have a particular body part exposed to relentless pressure develop injuries, according to the NPUAP (2018). Pressure injury patients with immobility issues are particularly susceptible since they cannot express their desires (Balzer et al., 2014). Consequently, it is up to every member of the multidisciplinary healthcare team to work in partnership and prevent pressure injuries. This doctoral project will probe into the critical aspect of PI prevention in a long-term care facility by stressing the influence of education. A persuasive introduction paragraph sets up this project by informing the depth of the problem. The significance and purpose sections stress the project’s urgency. Section 2 will apply a theory, discuss the project’s relevance to nurse practice, the project’s local background and content.

 

 

Section 2: Background and Context

Introduction

Section 1 discussed the problem statement, the purpose, the nature of the project, and its significance. Section 2 will include the project’s Concepts, Models, and Theories, the relevance to nursing practice, the local background and context, the role of the DNP student, and project team.

Concepts, Models, and Theories

The 1960s and 70s witnessed a boundless development in expanding the frameworks, theories, and models to control nursing practices. This period witnessed the launch of numerous conceptual frameworks and models developing from the meta-framework of the nursing field (Masters, 2014). The Novice-to-Expert Theory, developed by Patricia Benner, is a significant contribution to the understanding of skill acquisition, particularly in fields like nursing and education. As individuals move through the five stages of proficiency, they not only gain knowledge and skills but also experience a shift in their approach to practice and decision-making.

1. **Novice**: In this initial stage, individuals have no experience in the situation they’re dealing with. They rely heavily on rules and guidelines, often needing close supervision to avoid errors.
2. **Advanced Beginner**: At this stage, individuals begin to recognize recurring patterns and situations through experience. They can apply rules but still require assistance in complex situations.
3. **Competent**: Competent practitioners have a good grasp of their responsibilities and can perform tasks independently. They can plan and prioritize effectively, often developing a sense of organization and efficiency in their approach.
4. **Proficient**: Proficient individuals can see the big picture and understand how different elements interact within a situation. They apply complex decision-making skills and are more flexible in their responses.
5. **Expert**: In this final stage, practitioners possess intuitive understanding and can identify problems quickly. They operate with a high level of autonomy and are often seen as leaders in their field.

Benner’s theory highlights the importance of experience in learning and emphasizes that skill development is a progressive journey rather than a simple linear path. This framework provides valuable insights into training, mentorship, and professional development across various disciplines.

Relevance to Nursing Practice

The DNP project will address a significant subject among patients. In 2019, the CMS raised questions regarding the information gap related to PI care in healthcare workers. Additionally, the healing and treatment difficulties associated with pressure injuries can be challenging for nurses, impacting outcomes. Numerous recommendations regarding pressure injury prevention measures are recorded in the NPUAP (2018).  It contains the application of the Braden Scale, recognition of the risk aspects such as dietary shortage, skin evaluation, recurrent repositioning, maintaining the skin dry and clean, the usage of barrier skin protectant, and stopping forceful brass rubbing of the skin parts likely to breakdown.

Additional approaches were applied to address PI challenges. One essential approach often applied by CMS to ease this challenge is the denial of recompense for pressure injuries that develop when the patient is hospitalized, according to Dang (2019). Nurses may be cautious when treating and healing patients with skin breakdown. Consequently, utilizing the present project addressing PI will be crucial in managing the problem among the patients.

Recommendations include improving education to advance patient outcomes, accenting pre-emptive actions, and developing a culture of continuous education. Executing inclusive education, encouraging multidisciplinary partnerships, exploiting evidence-based procedures, carrying out frequent risk evaluations, and promoting a culture of unceasing perfection are also essential approaches to address these gaps in PI prevention. The doctoral project enhances nursing practice by demonstrating the positive impact of education on preventing pressure injuries, addressing a crucial gap in current literature.

Local Background and Context

The care facility where this project will be done serves community members with mild to severe mental and physical disabilities who depend on nurses and care staff to reposition and assist with their daily activities. Many patients are cognitively impaired, and wheelchair and/or bed bound. Immobility makes them critical victims of developing PI. PI is diagnosed among these patients in several phases. The care facility employs Registered Nurses (RNs) for direct patient health care from numerous backgrounds and experiences to take care of PI patients appropriately.

RNs are employed to accomplish direct patient care and carry out managerial responsibilities. The proficiency of some of the participants of this project is that they are RNs who work as wound care staff for the facility. These positions allow for evaluating the effect of education on pressure injury prevention in a long-term care facility. Possessing direct acquaintance regarding the PI patients’ requirements and the parts that necessitated improvement inside the care facility is an asset to this project.

The local evidence underlined the demanding problem of PIs in long-term care facilities, thereby vindicating the project’s practice-focused questions on the effect of education in preventing PIs and refining patient results. This doctoral project will be conducted in a long-term care facility with several shareholders, regulations, governance, vision, and mission to address PI prevention using education. Federal and State guidelines form the background for PI prevention by prompting strategies, procedures, and funding, which are vital to the achievement of this doctoral project.

Definition of terms or operational processes relevant to this doctoral project include

 

Pressure Injury: Pressure injuries are ulcers emanating from skin areas under pressure. The

pressure might come from sitting in a wheelchair, staying in bed, or wearing a cast for an

extended period (Lee & Lee, 2022).

Education Protocol: This is an organized proposal specifying the appropriate skills and knowledge required for efficient PI prevention.

Multidisciplinary Collaboration: This is the Teamwork amongst numerous healthcare disciplines inside a care facility to address PI prevention cooperatively.

Role of the DNP Student

Data analysis from the pre-tests and post-tests will be presented. The nurse will explore tendencies yet to be understood immediately after the training. The education resources will be revised as desirable, grounded on the analysis, and presented to the care facility for continuing PI prevention education. After completing the assessment phase, the DNP student will give suggestions based on the project literature review and results and present these suggestions to the project team. The nurse manager subsequently will review the suggestions and communicate to the Director of Nursing, who will begin the required protocol request for changes. The DNP project product will be the pre-test and post-test data, the recommendations founded on the results and the literature, and a strategy for impending project assessment. The DNP student will collect and analyze the pre and posttests. Results will be reported in aggregate format.

Role of the Project Team

The project team will consist of five people: a nurse educator, a manager, two wound care nurses, and the DNP student. The DNP student will support the project as the team’s project manager. Conversely, the Director of Nursing acts as a project advisor.

Summary

Section 2 presented evidence-based resources from sources including CINAHL, Medline, and Cochrane Library. Peer-reviewed articles highlight that educating nurses on pressure injury prevention is necessary. Not only is there a necessity, but numerous studies have indicated that educating and training nurses and other healthcare workers has reduced PI among community members, as per Zulkowski and Pieper (2014). The goal of the project will be to advance newly acquired knowledge into nursing practice.  Section 3 will describe the methods to be used to collect data and the methods to be used to analyze data.

 

 

Section 3: Collection and Analysis of Evidence

Introduction

Section 1 introduced pressure injuries in a long-term care facility and their negative impact on patient care. The project aims to provide additional education and training programs for nurses to prevent pressure injuries in a long-term care facility. Section 2 provided the background and context for the project. It highlighted the need for additional education for nurses to prevent pressure injuries, the impact of pressure injuries on healthcare, and the challenges nurses face in treating them. The section will discuss the role of the DNP student and the project team regarding the project’s participants, procedures, protections, data collection, and data analysis.

Practice-Focused Question(s)

The local problem will address in this project is the lack of educational resources in long-term care facilities. The identified gap in practice is the need for adequate education and training programs for nurses responsible for preventing pressure injuries. The practice-focused question for this project will determine how effective an educational program for nursing staff on pressure injury could increase knowledge and translate the knowledge into practice to prevent and treat pressure injuries. The project’s purpose aims to evaluate the impact of education on pressure injury prevention and treatment in a long-term care facility. The approach aligns with the practice-focused question by examining the effectiveness of additional education and training programs for nurses regarding pressure injuries. By evaluating the impact of these interventions, the project aims to identify best practices that can be used in other long-term care facilities to enhance pressure injury prevention and treatment outcomes.

Sources of Evidence

The evidence sources relied on to address the practice-focused question include published studies, reports, and guidelines related to pressure injury prevention and treatment in long-term care facilities. These sources will be used to identify best practices and evidence-based interventions for improving pressure injury outcomes. In addition, data related to pressure injuries will be collected from the long-term care facility where the intervention will be implemented. The evidence will be analyzed and synthesized to evaluate the most appropriate way to address the staff education project.

Evidence Generated for the Doctoral Project

Participants

Participants will include Rn’s only. Recruitment strategies will include developing working relationships with the participants, using email and phone calls requesting their participation and explaining a clear explanation of the projects purpose, the participants role, the benefits, and risks of participating, and ensuring their participation is voluntary. These will be nurses integrally involved in the care of the facility’s patients and are best suited to obtain knowledge and translate it to the care of patients and prevent pressure injuries. The relevance of the participants to the practice-focused question is crucial as they have first-hand experience in preventing pressure injuries, and their insights will be valuable in addressing the focused questions. These participants’ experiences will provide a unique perspective and understanding of the challenges and opportunities in preventing pressure injuries in long-term care facilities. Their participation will be voluntary, and their attendance at the staff training will provide their informed consent.

Procedures

The project will align with Walden’s Manual for Staff Education. Design and planning for the educational session will consist of developing a pre-test/posttest of 10 questions. The presentation will be presented to the participants. Following the educational presentation, the posttest will be provided to the participants. The pretest/posttest questions will consist of the same 10 questions. The DNP student will collect the results from both the pretest and posttest and analyze the results using Excel and present the results in a paired sample t test as an aggregate. These techniques align with the constructs of the doctoral project, which include pressure injury prevention education

Protections

Protections for the project’s participants will include developing a working relationship with each of them. Participants will develop a 3-digit number and enter it on both the pretest and posttest to safeguard their identity and uphold anonymity. The DNP student will keep the pretests and posttests maintaining confidentiality in a locked cabinet and not shared with other facility staff.  Attendance of the session will provide the participants with informed consent. The long-term care facility does not require IRB approval. The DNP student will obtain IRB consent from Walden University.

Analysis and Synthesis

The system used for recording, tracking, organizing, and analyzing evidence will be Microsoft Excel. This tool offers different functionalities for organizing and analyzing data, creating charts and graphs, and performing statistical analysis.

Ensuring the integrity of evidence is a crucial aspect of the project; the procedure to achieve this will be data validation, which involves checking the accuracy and completeness of data collected during the project. This will be done by verifying the data against the source documents and cross-checking the data. Outlier management will be implemented. Depending on the data’s nature, outliers will be excluded from the analysis. Finally, data security protects the data from unauthorized access or loss. This can be accomplished by using secure storage methods and password protected computers. . The DNP student will maintain possession of both the pretests and posttests in a secured cabinet. Implementing these procedures ensures the evidence collected is accurate, reliable, and safe.

Summary

Section 3 discussed the practice-focused question, the identified sources of evidence, and the methods used for the collection and analysis of data.  Section 4 will discuss the recommendations which will be formulated based on the findings. Additionally, the strengths and limitations of the staff education project will be identified.

 

 

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