Development of Nursing Practice Guidelines for Pressure Injury Prevention in the Intensive Care Unit, Phonphisai Hospital

Abstract

This action research study aimed to: 1) examine the existing problems and needs in nursing practice for pressure injury prevention in the intensive care unit (ICU), 2) develop nursing practice guidelines for pressure injury prevention in the ICU under the PPSH Model, and 3) evaluate the outcomes of implementing the developed guidelines. The study was conducted in three phases between October 2024 and March 2025. The sample consisted of seventeen ICU nursing personnel, five experts, and thirty ICU patients. The research instruments included a general information questionnaire, a problem situation questionnaire, a semi-structured interview guide, an expert appraisal form for guideline appropriateness, the PPSH Model nursing practice guidelines, the Braden Scale risk assessment tool, a clinical outcome assessment form, and a satisfaction questionnaire. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using frequency, percentage, mean, standard deviation, and the paired t-test.

            The findings across the three phases were as follows. In Phase 1, the overall level of existing problems was moderate (x̄ = 3.12, SD = 0.48), with patient risk assessment identified as the most problematic area (x̄ = 3.45, SD = 0.52), followed by environmental and equipment management (x̄ = 3.05, SD = 0.41), and education for relatives and caregivers (x̄ = 2.89, SD = 0.50). In Phase 2, the nursing practice guidelines were developed under the PPSH Model, encompassing four core components: Patient-centered Prevention, Proactive Environment Management, Skin Surveillance Monitoring, and Holistic Engagement and Education. The developed guidelines were rated by experts at the highest level of appropriateness, with an overall mean score of 4.72 (SD = 0.15). In Phase 3, following implementation of the guidelines, personnel adherence to nursing practice significantly increased from 3.11 ± 0.48 to 4.40 ± 0.49 (p < .001). The quality of pressure injury preventive care received by patients improved from 2.85 ± 0.42 to 4.32 ± 0.37 (p < .001). The proportion of patients at moderate risk of developing pressure injuries decreased from 40.0% to 23.3%, no new cases of pressure injuries were identified, and satisfaction with the guidelines was rated at the highest level (x̄ = 4.56, SD = 0.37).

            In conclusion, the PPSH Model represents an appropriate and practically applicable nursing practice framework that effectively reduces the risk of pressure injury development among ICU patients. It is well-suited for sustained use within a community hospital context and may be adapted for application in units with comparable clinical settings.