Evidence-Based Nursing Knowledge and Skills Assignment

PICOT Question & Clinical Problem Statement

PICOT: In immobile adult medical-surgical patients (P), how does implementing a bundled pressure injury prevention protocol with silicone border dressings, two-hour repositioning, and high-protein supplements (I) compared to standard Braden-based care (C) reduce hospital-acquired pressure injury incidence (O) within eight weeks (T)?

Evidence Search & Appraisal Strategy

The nurse researcher conducted a structured search in CINAHL, PubMed, and Cochrane using keywords such as “pressure injury prevention,” “silicone border dressings,” “repositioning schedule,” and “high-protein supplementation.” Boolean operators (AND/OR), MeSH terms, and filters for peer-reviewed publications within the last five years ensured current, high-level evidence. Twelve studies met inclusion criteria: 5 randomized controlled trials, 3 quasi-experimental cohorts, 2 integrative reviews, and 2 clinical practice guidelines.

• Appraisal Tools: Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) evidence and quality rating scales.
• Level I Evidence: RCTs demonstrating 43% reduction in sacral pressure injuries with prophylactic dressings and 38% reduction with high-protein supplements.
• Level II-III Evidence: Cohort studies confirming adherence to two-hour turning protocols improves skin integrity scores.
• Guideline Alignment: Recommendations from the National Pressure Injury Advisory Panel (NPIAP) and American Association of Critical-Care Nurses (AACN).

Translation & Implementation Plan

Guided by JHNEBP’s Translation phase, the nurse devised an eight-week pilot on a 32-bed unit. Key elements included stakeholder analysis, cost-benefit evaluation, and change-management strategies grounded in Kotter’s model.

• Stakeholders: Wound care nurse specialist, nurse manager, dietitian, physical therapy, and bedside staff nurses.
• Education: Simulation-based competency sessions on dressing application and repositioning documentation using the electronic health record (EHR).
• Workflow Tools: Bedside turning clocks, EHR smart phrases for risk assessment, and automated dietitian referrals for high-protein supplementation.
• Resource Allocation: Cost analysis estimated $48 per patient for silicone dressings offset by reduced treatment expenses for stage III/IV ulcers.

Outcome Measures & Data Collection

The evaluation plan combined structure, process, and outcome indicators:

• Primary Outcome: Incidence of hospital-acquired pressure injuries per 1,000 patient days (monthly WOCN audit).
• Process Metrics: Repositioning compliance (>90%), nutrition consult completion, and dressing adherence (daily charge nurse checklist).
• Balancing Measures: Staff workload perception and patient comfort scores.

Data collection leveraged the EHR reporting dashboard and wound care documentation. Monthly PDSA cycles allowed rapid-cycle testing, with adjustments made to supply management and bedside handoff prompts.

Results & Impact

Over eight weeks, the unit achieved a 52% reduction in hospital-acquired pressure injuries (from 1.15 to 0.55 per 1,000 patient days). Repositioning compliance improved to 94%, and protein supplement adherence reached 88%. Staff engagement scores increased by 12% due to enhanced interdisciplinary collaboration.

Reflection & Professional Growth

The nurse reflected on the importance of aligning evidence with unit resources, noting challenges in maintaining documentation compliance during high census periods. Recommendations include sustaining the nurse champion role, integrating wound care triggers into bedside shift report, and scaling the bundle to surgical intensive care units. Future inquiries will explore adding microclimate management surfaces and digital pressure-mapping technology.

Why This Evidence-Based Nursing Assignment Excels

• Develops a clinically relevant PICOT question anchored in patient safety and quality outcomes.
• Demonstrates rigorous literature search techniques with transparent inclusion/exclusion criteria.
• Applies established appraisal frameworks to synthesize high-level evidence.
• Translates findings into realistic nursing workflows that respect staffing ratios and budget constraints.
• Integrates interprofessional perspectives, ensuring dietitian and therapy collaboration.
• Utilizes PDSA cycles and dashboard metrics for continuous quality improvement.
• Includes reflective practice insights aligned with Magnet and QSEN competencies.