Development of a care model to prevent pressure ulcers in critically ill patients Thung Song Hospital

Abstract

This research and development study aimed to develop a care model for preventing ulcers in critically ill patients, and compare the incidence of pressure ulcers, the competency of professional nurses, and the supervisory behaviors of nursing administrators before and after implementing the model. The study was divided into four phases: 1) A survey and synthesis of significant issues regarding pressure injury prevention. This phase involved 8 nursing administrators. 2) Development of a care model to prevent pressure ulcers from admission to discharge. This phase involved 57 professional nurses from Thungsong Hospital, consisting of 12 nursing administrators and 45 professional nurses. The care model to prevent pressure ulcers consisted of three main components: (1) Admission phase risk assessment for pressure ulcers, skin assessment, and documentation of pressure ulcer risk. (2) In-hospital care phase implementation of care practices was based on clinical guidelines and a supervision manual, using an adapted summary version of the EPUAP guidelines and supervision based on Proctor’s model. And (3) the discharge phase, which comprised education for the family on pressure ulcer prevention using an e-book. 3) Pilot implementation of the model. And 4) model expansion and data analysis, the data were analyzed using descriptive statistics, paired t-tests, and Wilcoxon Signed test. Results revealed that:

1. The care model for critically ill patients was implemented in three phases: Phase 1, the admission phase, focused on risk assessment for pressure ulcer development, skin assessment, documentation, and communication of risk information. Phase 2, the in-hospital care phase, emphasized adherence to evidence-based clinical practice guidelines and included routine monitoring and supervision of nursing practices. Phase 3, the discharge phase, involved educating caregivers using electronic media.

2. The application of this care model significantly reduced the incidence of pressure injuries among critically ill patients. In addition, professional nurses demonstrated a significant improvement in their competency related to pressure ulcer prevention. Furthermore, nurse administrators exhibited a statistically significant increase in their supervisory behaviors, with a significance level of p < 0.05.

It is crucial to consistently promote the implementation of patient care models for pressure injury prevention, as well as to enhance the competencies of professional nurses in nutritional assessment, in order to ensure patient safety, prevent complications, and improve the quality of care.