Date of Award

Spring 6-6-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Bomin Shim

Faculty Reader

Bomin Shim

Faculty Reader

Carrie Fry

Executive Summary

Executive Summary

Title: Improving Hospital Acquired Pressure Injury Prevention Knowledge and Attitude Among ICU Nurses

Background and Significance: Despite prevention strategies, hospital acquired pressure injuries (HAPI) continue to occur, especially in critical care, raising the question whether some pressure injuries are unavoidable. Pressure injuries are associated with substantial morbidity, thereby burdening the patient and the healthcare system (EPUAP, 2019). To stop pressure ulcers from developing in patients who are at risk, healthcare staff need to be well informed about how to prevent this problem. It is important to understand what type of information healthcare staff need, how it might best be delivered and whether education can prevent pressure ulcers from developing. Nurses as team member have important roles in the protection of skin integrity and the prevention of complications. Education in the intensive care unit (ICU) is vital in developing and maintaining competency and is essential to providing the nurse with the knowledge to make the best-informed evidence-based practice decisions for the care of the patients (Porter-Armstrong et al., 2018).

Purpose: The purpose of this quality improvement project was to provide a multimodal hospital-acquired pressure injury (HAPI) prevention educational program to intensive care unit (ICU) nurses. The multimodal educational intervention designed to improve nursing knowledge and attitude of HAPI prevention, comprised of posters, flyers with resource websites, and a QR code to easily access Braden Scale review guideline that is used by project setting organization. The pre- and post-intervention surveys were utilized to evaluate the effectiveness of the multimodal education intervention on intensive care unit nurses’ knowledge and attitude of hospital-acquired pressure injury prevention.

Methods: This quality improvement project used a quantitative study method with a quasi-experimental pre-survey and post-survey design. The project was implemented in the ICU, in one of the major hospitals in Washington. Over a two-month period, a convenience sample of ICU nurses participated in the educational intervention and completed the Pressure Sore Survey. Participation was voluntary and anonymous, whereby, de-identified data was collected for this project.

Results/Outcomes: For this facility, the ICU nurses held a fairly positive attitude on pressure injury prevention pre- and post-intervention. The 11 questions in the Pressure Sore Survey were analyzed as separate variables as they reflect participants’ attitude in pressure injury prevention practice. A significant finding in question nine, on the Pressure Sore Survey, asked if clinical judgement is better than any pressure sore risk assessment tool (Braden Scale), the post-intervention participants strongly disagreed in comparison to the pre-intervention participants. Because the Braden Scale was highlighted in the multimodal educational intervention, its focus as an important risk assessment tool, impacted the significant difference for this particular question.

Sustainability: A key feature that emerged was the post-intervention participants had an improved outcome in their understanding of the Braden Scale as an important risk assessment. Because the Braden Scale was highlighted in the education module, this signifies that the participants may have been interested in reading the educational materials. It is recommended that education would benefit the nurses in HAPI prevention. In order to sustain an education initiative, a team of HAPI prevention champions from all levels of leadership and staff must be achieved. The champions will need to be tasked to update education materials, yearly training, and engage staff to improve HAPI prevention and practice.

Implications for Practice: There are a multitude of factors which contribute to pressure injuries. This DNP project meant to address the gap in improving ICU nurses’ knowledge and attitude in pressure injury prevention. Although the ICU nurses had positive attitudes and knowledge of pressure injury prevention, that attitude and knowledge may not be reflected in clinical practice. The pressure injury occurrence remains high and is the leading cause of adverse events (Washington State Department of Health, 2022). Perhaps, future studies should explore the gap in nurses’ attitude and actual pressure injury practice in this ongoing phenomenon.


European Pressure Ulcer Advisory Panel. (2019). Prevention and treatment of pressure ulcers: clinical practice guidelines.

Porter-Armstrong, A. P., Moore, Z. E., Bradbury, I., & McDonough, S. (2018). Education of healthcare professionals for preventing pressure ulcers. Cochrane Database Systematic Review 2018(5).

Washington State Department of Health. (2022).

JollimoreSPUposter2023.pdf (221 kB)
DNP Poster