University Nursing Capstone: Pressure Ulcer Prevention Proposal

This nursing capstone project addresses the prevalent issue of pressure ulcers in frail, older adults within hospital settings, proposing a change in patient handling practices to mitigate their development. The assignment includes a problem statement highlighting the adverse health impacts of pressure ulcers, followed by a PICOT question focusing on the effectiveness of frequent repositioning in reducing ulcer formation. A literature search using the CINAHL database supports the proposal, which utilizes Roger's Change Theory to outline an implementation plan. The plan details steps for clearly defining the change, assessing its impact, developing a communication strategy, providing effective training, and measuring outcomes. Potential barriers, such as lack of health literacy and funding, are identified along with facilitators like effective communication and supportive team structures. The project concludes with a strong emphasis on the need for rigorous training to successfully implement frequent repositioning strategies, supported by the evidence gathered, to improve patient outcomes.

Running head:NURSING ASSIGNMENT
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Name of the Student
Name of the university
Author’s note

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Background
The prevalence of the Pressure ulcers in frail older adult continues to be high and is very
costly the especially in those who had been suffering from chronic diseases (Jaul et al. 2016).
There are multiple factors that causes pressure ulcers in the geriatric population admitted in a
hospital setting. The percentage is higher in the geriatric population who are functionally
impaired. However, it has been noticed in some studies that frequent turning or repositioning of
the patient can decrease the chance of pressure ulcer in elderly people.
This paper will propose a change in way elderly people are handled in clinical settings
with the aim of reducing the chance of the development of pressure ulcers. A problem statement
will be discussed in this paper followed by a PICO question along with a literature search by
using CINAHL database. The change theory that should be used in this PICO is the ROGER’s
change theory). Finally an implementation plan will be proposed.
Problem statement
There are several adverse health impacts associated to pressure ulcers. It affects the
quality of life of the patients, mortality and morbidity. Once a pressure ulcer is developed, it can
also develop serious problems like infection with the potential of turning to sepsis. In a study, it
has been mentioned that pressure ulcers affected the lives of the inpatients emotionally,
physically, mentally and socially. Patients have a varied level of preoccupation with their ulcers.
A study by Sharp, Moore andMcLaws, (2019) has claimed that a two-hourly repositioning of the
patient can be helpful in preventing pressure ulcers in elderly. Hence, this paper will try to

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present a strong evidence of whether repositioning of elderly patients would reduce the chance of
pressure ulcers in elderly people, in comparison to not repositioning of the patients.
Purpose of the change proposal
The purpose of the change proposal is to make an official suggestion about how this
evidence based suggestion of repositioning elderly patients can mitigate the scope of formation
of pressure ulcers in older population. The aim of the proposal is to point out the exact problem
that is in need of a change in the geriatric ward for avoiding a common problem like pressure
ulcers.
PICOT
Geriatric population in a long-term care setting, how does turning/ reposition patients at a
frequent interval as compared to not turning/reposition patients decrease the development of
pressure ulcers within 90 days?
Population (P) Geriatric population suffering from pressure ulcers
Intervention (I) Turning/ reposition patients at a frequent interval
Comparison (C) Comparison to not turning/reposition patients
Outcome (O) Decreasing the development of pressure ulcers
Time (T) 90 days
Literature search strategy employed
In order to find out literatures CINAHL data base has been searched, by using appropriate key
terms like Elderly AND Pressure ulcers , Pressure ulcers AND reposition. The initial search
produced 36-40 papers from which only 5 papers were selected.

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Evaluation of the literature
The paper by Walia et al. (2013) gave an account of the efficacy of the monitoring
devices in the prevention of pressure injury in the older adults. Miles, Nowicki and Fulbrook,
(2013) gave an account of the role of repositioning in preventing pressure ulcers in elderly
people. In relation to this Bradford, (2016) has stated that provision of a good pressure area care
to elderly patients are necessary for the nurses. It has also been stated that care of the pressure
area involves proper assessment of the skin of the patient and regular repositioning for
preventing pressure injury. This is Cochrane review is supported by several references.
Applicable change or nursing theory utilized: (Please uses ROGER’s Change Theory- The
five stages)
Roger’s theory of change emphasizes on five phases that through which a change is
implemented in a health care setting. Any changes that needs to be implemented should follow
the five phases – Knowledge, persuasion, decision, implementation and confirmation. The initial
phase is to be exposed to new ideas, which is only possible by brainstorming through scientific
evidences suggesting scientific, valid and reliable recommendations (Rogers, 2014). The second
step would be to disseminate the idea to the higher authority or to discuss the same with the peers
having interest and experience in the same field (Gesme& Wiseman, 2010). The next step is to
decide on the values and the weightage of the ideas, whether to adopt the idea or to reject it. The
penultimate decision is the implementation of the plan. Introduction of any changes in an
organization would bring about initial conflicts. A manager or a public health practitioner should
have the leadership qualities of managing conflicts. This should be followed by education and
training to the nurses about the new strategies that should be followed. Finally, an individual
should evaluate as whether the strategy that has been implemented has been able to bring about

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any fruitful results. This could be measured by a risk assessment and audit analyst, tallying the
baseline rate of pressures ulcers with the current occurrence. After the evaluation, the
continuation of the evidence based practice should be determined depending on the positive
outcomes. In the paper Gillespie et al. (2017) , it has been stated that assessments of the effect of
repositioning on the prevention of pressure in elderly patients.
Proposed implementation plan with outcome measures
The first step in the implementation of the changes is to clearly define the change that
that has to be brought. It should be reviewed as per the organizational objectives and the
performance goals. The next step would be assess the impacts of the change at the various
organizational level (Grol&Wensing, 2013). For example, the impact of introducing the rule of
repositioning geriatric patients in a long term care setting will bring about positive outcomes in
geriatric patients. The organization can form a blueprint for identifying the areas where the
training and the support is required for educating the workforce.
The next step will be to develop a communication strategy. The change that will take
place needs to be communicated to all the staffs. This can be done by meetings, setting up the
bulletin boards, newsletters. Effective training needs to be provided to inform the practice and to
teach the skills and the knowledge that will be required to inform the practice(Grol&Wensing,
2013). After the implementation of the changes, it is necessary to measure, whether the training
has been effective for the nurses.

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Identification of potential barriers to plan implementation, and a discussion of how these
could be overcome
One of the most important barrier to the implementation of the evidence base practice in
an organization is lack of health literacy, lack of time to go through scientific literatures, heavy
workload and lack of staffs experienced in EBP (Khammarnia et al., 2014). Hospitals staffs
might be overburdened with work and might find it difficult to attend the geriatric patients and
reposition them. Another important barriers is the organizational funding. The organization
should have enough funding from the government in order to provide training to the nurses.
Some of the facilitators of the implementing evidence based practice is effective
communication between the health care workers. A supportive team structures enables staffs to
feel that they had been working towards the achievements of the goals (Lavallée et al.,
2017).Involvement of the head of the organization in the change can also facilitate
implementation of changes in an organization.
In conclusion, it can be stated that all the evidences that has been gathered by the
literature search rightfully points towards the fact , that frequent repositioning of the patient can
reduce the change of pressure ulcers in geriatric patients. However, in order to introduce to the
health care setting, a rigorous training is needed.

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References
Bradford, N. K. (2016). Repositioning for pressure ulcer prevention in adults: a Cochrane
review. International journal of nursing practice, 22(1), 108-109.
Gesme, D., & Wiseman, M. (2010). How to implement change in practice. Journal of oncology
practice, 6(5), 257.
Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., Whitty, J. A., & Thalib, L. (2014).
Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic
Reviews, (4).
Grol, R., &Wensing, M. (2013). Effective implementation of change in healthcare: a systematic
approach. Improving Patient Care: The implementation of change in health care, 40-63.
Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the
implementation of change in health care. John Wiley & Sons.
Jaul, E., Barron, J., Rosenzweig, J. P., &Menczel, J. (2018). An overview of co-morbidities and
the development of pressure ulcers among older adults. BMC geriatrics, 18(1), 305.
Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., &Setoodehzadeh, F. (2015).
Barriers to implementation of evidence based practice in Zahedan teaching hospitals,
Iran, 2014. Nursing research and practice, 2015.

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Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to
preventing pressure ulcers in nursing home residents: A qualitative analysis informed by
the Theoretical Domains Framework. International journal of nursing studies, 82, 79-89.
Miles, S. J., Nowicki, T., &Fulbrook, P. (2013). Repositioning to prevent pressure injuries:
evidence for practice. Australian Nursing and Midwifery Journal, 21(6), 32.
Rogers, P. (2014). Theory of change. Methodological briefs: impact evaluation, 2, 16.
Sharp, C. A., Moore, J. S. S., &McLaws, M. L. (2019). Two-Hourly Repositioning for
Prevention of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse?.Journal of
bioethical inquiry, 16(1), 17-34.
Walia, G. S., Wong, A. L., Lo, A. Y., Mackert, G. A., Carl, H. M., Pedreira, R. A., ...& Sacks, J.
M. (2016). Efficacy of monitoring devices in support of prevention of pressure injuries:
systematic review and meta-analysis. Advances in skin & wound care, 29(12), 567-574.

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Appendix