UNIDA, Anabel U.

JOURNAL REPORT

TITLE:

Pressure Injury Prevention Practices Among Medical Surgical Nurses in a Tertiary Hospital: An
Observational and Chart Audit Study

SUMMARY:

Pressure injuries are a common occurrence in hospitals, negatively impacting patient safety and
quality of care. Most pressure injuries are preventable with effective prevention strategies.
However, it is unknown how different environments influence their use of prevention strategies.
The purpose of this study was to describe and compare pressure injury prevention strategies
used by Chinese medical and surgical nurses. All data were collected in two medical and two
surgical wards of a tertiary hospital using semi-structured observations and chart audits. The
observations were patient-centered; any prevention practices received by the patient were
documented, and a chart audit was used to identify documented prevention strategies.

Each prevention strategy's frequency was reported, and differences between medical and
surgical wards were examined. A total of 577 patients were subjected to a risk assessment
upon admission, observed and their charts were audited (n = 294, 50.9% medical; n = 283,
49.1% surgical). Results revealed that repositioning was the most commonly used strategy on a
regular basis. Skin care, nutritional risk screening, and the use of support surfaces, on the other
hand, were subpar. Although patient education was uncommon, audited charts shows that it
was conducted.

More medical patients had clean and hydrated skin, but more surgical patients had barrier
creams, a support surface, and more nutrition support, and if they were in a prone position, they
were more likely to be turned after 2 hours and repositioned after sitting in a chair for an hour.
Prevention strategies were more likely to be documented in the charts of surgical patients.
Despite the fact that pressure injury prevention guidelines recommended a variety of prevention
strategies for nurses to use, the observed use of some strategies such as nutrition, skin care,
and support surfaces was suboptimal. Nurses relied heavily on repositioning to prevent
pressure injuries.

NURSING INSIGHTS:

The human integumentary system (mostly the skin) is considered to be the first line of defense
against infections and other disorders. According to Kim and Dao, this system performs several
intricate activities in addition to barrier functions, such as body temperature management, cell
fluid maintenance, Vitamin D synthesis, and stimulus detection (2022). Given the post-operative
status of surgical patients, infection is the most likely to arise, given that the skin has already
been altered by surgical incision/s and the decrease in movement. Furthermore, further skin
trauma, such as bed sores or pressure injury, is conceivable. As a result, attentive and
appropriate preventive measures, such as those described in this publication, must be
implemented.

Furthermore, the study described various ways and preventive care for bed sores or pressure
injuries performed in Chinese hospitals. This gives a comprehensive overview of what is
commonly utilized in hospital settings, particularly in the medical-surgical field, and can be used
by health professionals and medical students. In which, as a medical/nursing student, the data
mentioned specifically on the common preventive care performed in the hospital provided me
with an idea of the different interventions that I must consider when taking care of a surgical
patient, specifically the repositioning of the patient every two hours, provision of skin hygiene,
nutritional risk screening, provision of good skin hydration, and the use of support surfaces, but
also taking note of providing health education which seen as not prioritized.

NURSING IMPLICATIONS:

Despite the fact that the study was conducted in a Chinese tertiary hospital, it offered thorough
information about the preventive care provided by surgical nurses to surgery patients in order to
avoid the occurrence of bed sores. Data are relevant for usage as a baseline in evaluating the
quality of care and the effectiveness of these interventions on improving one's health status in
hospital settings. As well, hospitals will be able to detect which actions are lacking in order to
increase skin bed sore prevention and improve current practices. One example is provided in
the outcome, in which health education was not widely conducted but was nonetheless
intervened. It can be observed from this that it has to be improved in order to gain better patient
cooperation.

To summarize, the major contribution of this research to the nursing area was the provision of
data to identify, enhance, and promote skin disease preventative care among surgical patients
in order to provide quality and appropriate nursing care at all hospital levels.

REFERENCES:

Li, Z., Marshall, A. P., Lin, F., Ding, Y., & Chaboyer, W. (2022). Pressure injury prevention
practices among medical surgical nurses in a tertiary hospital: An observational and chart audit
study. International wound journal, 19(5), 1165–1179. https://doi.org/10.1111/iwj.13712