Peri-operative nurses’ knowledge and reported practice of pressure injury risk assessment and prevention: A before-after intervention study

Abstract

BackgroundPatients are at risk of developing pressure injuries in the peri-operative setting. Studies evaluating the impact of educational interventions on peri-operative nurses’ knowledge and reported practice are scarce. The purpose of this study was to evaluate the effect of a multifaceted intervention on peri-operative nurses’ (a) knowledge of pressure injury risks, risk assessment and prevention strategies for patients in the operating suite; and (b) reported practice relating to risk assessment practices and implementation of prevention strategies for patients in the operating suite.MethodsA before-after research design was used. A convenience sample of all registered and enrolled nurses employed in two hospitals’ operating suites was recruited. A multifaceted intervention was delivered which comprised a short presentation, educational materials and reminder posters. A 48-item survey tool was completed pre-and post-intervention to measure self-reported knowledge and practice.Results70 eligible peri-operative nurses completed both surveys. Post-intervention, statistically significant improvements were seen in knowledge of correct descriptions of pressure injury stages (p=0.001); appropriate reassessment for patients with a new pressure injury (p=0.05); appropriate actions for patients with an existing stage 1 (p=0.02) and stage 2 pressure injury (p=0.04). Statistical improvements were also seen in reported practice relating to an increase in the use of a risk assessment tool in conjunction with clinical judgement (p=0.0008); verbal handover of patients’ pressure injury risk status from the operating room nurse to the recovery room (p=0.023) and from the recovery room nurse to the postoperative ward nurse (p=0.045). The number of participants reporting use of non-recommended and recommended pressure-relieving strategies was unchanged.ConclusionA multi-faceted educational intervention can improve some aspects of perioperative nurses’ knowledge and reported practice such as risk assessment practices but not others such as use of recommended pressure-relieving devices. Further research is required to ascertain effective interventions which improve all areas of practice and knowledge, particularly in the use of appropriate pressure-relieving devices in order to prevent pressure injuries in surgical patients.

Adherence to evidence‐based pressure injury prevention guidelines in routine clinical practice: a longitudinal study

“…However, previous research suggests several factors influence the completion of PI risk assessment tools. First, adequacy of knowledge and limited training in use of PI screening tools may affect nurses' completion of PIP risk assessment tools. Second, nurses consider some patient characteristics more important than others in predicting PI risk factors, which may influence whether or not risk assessment is performed .…”

Pressure injury prevention in the perioperative setting: An integrative review

“…Half (five) of the studies were from the US [12][13][14][15][16] and three from Europe [17][18][19] . Seven studies used prospective research approaches 13, 14, 16-18, 19,20 and eight studies consecutive sampling methods 9,[12][13][14][15][18][19][20] . The majority (seven out of ten) of the included articles were conducted at a single hospital site 9,12,14,15,[17][18][19] .…”

“…arm board, facial pillow, pillow, gel pad or heel pad) were used for different surgical positions. However, the effectiveness of these support surfaces and positioning aids varied [12][13][14][17][18][19][20] . In the literature, using higher specification foam mattress and/or overlays in the operating room rather than the standard hospital foam mattress to prevent or reduce the incidence of intraoperative PI is recommended 8,21,22 .…”

“…One included article focused on educational interventions to improve perioperative health professionals' PIP practice, including communication and the use of positioning aids 20 . Effective interprofessional communication, such as routine documentation, is an important PIP strategy 19 .…”

“…Effective interprofessional communication, such as routine documentation, is an important PIP strategy 19 . Sutherland-Fraser et al 20 and Sewchuk et al 12 suggested all members of perioperative teams, rather than members of just a single discipline, e.g. nursing, should collectively be involved in communication around PIP.…”