SHEILA A SAMUELS RN PICO QUESTION For staff

SHEILA A. SAMUELS RN

PICO QUESTION For staff nurses in the medical surgical unit ( P) at Bronx Lebanon Hospital, will education about pressure ulcer assessment and treatment (I), decrease the incidence of Pressure ulcers (C) along with pressure ulcer assessment and treatment (O) compared to inadequate education?

A pressure ulcer is a debilitating and chronic wound. Pressure ulcers (PUs) are a major problem in all the healthcare settings that affect about 10% of the hospitalized and about 5% if the community living patients. The patients prone to PUs are obese people, the elderly and patients with spinal cord injuries ( Vasiliadis, 2012)

Bronx Lebanon is currently having a increase in the incidences of PUs patients attending the medical surgical unit. This is due to the lack of PU education provided to patents and their family from the staff nurses. Hence, this research study is aimed at the provision of PU training to the surgical unit.

In taking care of patients with PUs appropriate education of the staff nurses is important in risk assessment and treatment. The implementation change in the medical surgical unit at Bronx Lebanon Hospital is aimed at educating nurses on PUs risk assessment and proper treatment of PUs. Daily education of PUs will improve the skills of the medical- surgical staff nurses, thereby decreasing the incidences of PUs.

Change Continue. . • According to Russel (2013), Lewin’s theory is widely used and consists of three stages: unfreezing, moving the stage and refreezing. • The evidence- based program for change targets in determining whether adequate education of the medical, surgical unit staff nurses on risk treatment and treatment of PUs result to reduced incidences of PUs. • The main purpose of the change project proposal is to provide significant monthly sessions of nursing education on the risk assessments and treatment of PUs for three months. • Acknowledgment may perhaps be achieved by surveying the nurses in the medical, surgical unit in order to evaluate their level of knowledge in risk assessment and treatment of PUs.

RESEARCH LITERATURE REVIEW Mohamed and Wehieda (2015), conducted an assessment of the effects of implementation of educational program on the control of PUs on nurses knowledge. The results showed a definite improvement in the immobilized patients demonstrates the decrease in PU incidences. The research literature review gives confirmation nurses demonstrate adequate knowledge in PUs in relation to prevention, risk assessment and correct wound care.

First in Lewin’s Model Russel (2013 ), is the unfreezing stage. I will make sure the committee surveys the medical surgical unit • The study population will department. I will also include the medical ensure that staff surgical unit staff nurses, nurse mangers, at Bronx Lebanon who patients, local help in prevention and community members management of PU in elderly patients and key stakeholders are involved in implementing this change. • The PIP proposal for change will assist nurses in enhancing their knowledge in the management of patients with pressure ulcers. 2. Next is the moving stage. Every two months the nurses will be educated on new ways to prevent and treat PUs. I will conduct monthly seminars about the change process to dispel any negative responses from the resistant nurses 3. Finally, the refreeze stage. PUs compliance will enhance the guidelines in relation to the periodic surgical unit nursing staff education in PU management and prevention at Bronx Lebanon Hospital

Methods for Implementation of the Proposed Practice Change As a medical, surgical certified nurse, I will conduct monthly PUs seminar with the medical surgical staff nurses discussing how to apply Lewin’s model for change to our daily routine.

METHODS FOR IMPLANTATION CONTINUED. . • It will be mandatory for ALL nurses and unit managers in the medical surgical unit to attend the education PUs change program and attend the educational seminar for a period of eight weeks. 1) The approval for undertaking the PUs change project will receive acceptance to implement PUs changes at Bronx Lebanon Hospital facility Team organization. 2)The team comprises the researchers, the nursing director, nurses administrators, unit managers and PUs specialist for defining the areas for nursing knowledge as well as deficiencies in documentation 3) The Pilot Project aims at determining whether the project is practical. 4) PUs pre-test and post test will be given before and after every educational session to acknowledge strengths and weakness of the staff nurses 5) Data retrieval at the beginning of the first educational program session and then again after the fourth week will ensure accurate PUs documentation. 6) The eight-week educational program settings will be carried out depending on the response from the nurses and collected data.

At Bronx Lebanon Hospital one obstacle that may halt the change program is lack of enforcement and or punishment for nurses that do not embrace this program. I will no longer be a standby and allow patients with untreated PU to sustain pain and discomfort that is preventable. At the start and end of my shift I will document the patient’s current PUs stage on my flow sheet. Upon my return to my shift, I will compare the patients PUs stages with the current flow sheet. If the PU condition has worsened I will discuss this occurrence with the nurse management of the medical surgical unit. The evaluation of the change will be determined by assessing the outcomes based on the educational program results. Project evaluation will involve the participation of the nurses in the documentation of PUs and assessment of the score on both pretest and posttest questionnaires. On the 10 - item questionnaires the correct response will be awarded with a 1 while incorrect responses will receive a 0 with a possible score of 10 points. These questionnaires will gauge the impact of the educational program for change.

The important outcomes of the change program are an increase in the nursing knowledge and improvement of the quality of life of pressure ulcer patients as a result of several educational program sessions. Reduction in the incidence rate of pressure ulcer stands anticipated. Hereafter, the implementation of the change program will contribute to the improvement of the overall patient outcomes but there is a need for further evaluation of the change program.

REFERENCES Mohamed, S. A. , & Weheida, S. M. (2015). Effects of implementing educational program about pressure ulcer control on nurses’ knowledge and safety of immobilized patients. Journal of Nursing Education and Practice, 5, 12 -20. Roussel, L. (2013). Management and leadership for nurse administrators. Burlington, MA: Jones & Bartlett Learning. Vasiliadis, A. V. (2012). Epidemiology map of traumatic spinal cord injuries: A global overview. International Journal of Caring Sciences, 5, 335 -347. •