Date of Award

Fall 2010

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Jill Winters

Second Advisor

Susan Cashin

Third Advisor

Shelly Malin, Christine Shaw

Abstract

Pressure ulcers are defined as localized areas of tissue destruction that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. Although any hospitalized child is at risk for the development of a pressure ulcer, the critically ill child is at increased risk. The critical care environment poses special challenges to preventing the development of pressure ulcers secondary to the high acuity of patients and the highly invasive nature of interventions and therapies those patients receive. The incidence of pediatric pressure ulcer development in the critical care population has been reported to be as high as 10.2 to 27%.

This prospective, quasi-experimental study was conducted in order to determine whether a specific pressure ulcer prevention bundle was associated with a significant reduction in pressure ulcer development in infants 0 to 3 months old in the pediatric intensive care unit. The four main components of the pressure ulcer prevention bundle were (S) support surfaces, (K) keep turning every 2 hours, (I) incontinence management, and (N) nutrition consultation. The second element of the study was a survey of the nursing staff of the pediatric intensive care unit to gain a better understanding of the barriers and facilitators to implementing the S.K.I.N. care pressure ulcer prevention bundle.

The implementation of the S.K.I.N. care bundle is associated with a significant drop in pressure ulcer incidence from 18.8% to 6.8%. The infants who developed pressure ulcers in the experimental group received significantly more mechanical support and had significantly longer lengths of stay than the infants who did not develop a pressure ulcer. The survey demonstrated that competing demands on nurses' time as the biggest barrier to implementation of the pressure ulcer prevention bundle. Having appropriate supplies and easy access to the support surfaces were the biggest facilitators of implementing the bundle.

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