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This section is for the student to summarize the strength of the body of evidence (quality, quantity, and consistency), write a summary statement based on your conclusions drawn from the literature review, and provide a recommendation for practice change based on scientific evidence. The student will create an algorithm and will include it in as a figure. This could be the intervention of the PICOT questions.

Project Setting

This section should include a description of the setting of the DNP scholarly project. Include the type of setting (nursing home), da typical client’s description (rehabilitation patients including patients who are long term residents), the vision and mission, and organizational structure and culture. Describe how organizational need was established (based on the importance of improving patient care). Identify the stakeholders. Describe how organizational support was confirmed and plans for sustainability (it was confirmed by approaching them and presenting the proposal). Briefly discuss the SWOT analysis and include it as an Appendix.

Prevention of Pressure Ulcers in Skilled Nursing Facilities in Miami, Florida
Research Questions
How do nursing staff working in nursing facilities perceive their knowledge about
pressure ulcer prevention?
How can education intervention reduce the incidence of pressure ulcers in the long-term
Proposal Objectives
The study aims at attaining diverse objectives related to reducing the incidents of PUs in
all of Miami’s nursing facilities. In this case, some of the anticipated objectives include improved
quality of care such as improved and regular assessments, repositioning, nutrition, and nursing
skills and knowledge in dealing with and preventing pressure ulcers. After going through the
factors that are attributed to the escalating of PUs incidents in the region, the study aims at
creating viable interventions based on prior research studies carried out in other regions that are
working effectively. The study’s main objective is to assess the facility’s staff own perception of
pressure ulcer prevention and how to properly manage patients with PUs in the facilities (Padula,
2019). The training will equip the nursing staff with enough education on diverse risk factors
associated with PUs development. The study will also equip nurses with effective pressure injury
prevention measures. The study will propose a questionnaire that will be answered by the
facility’s staff to determine with efficacy how they perceive their knowledge on management and
prevention of pressure ulcers. Equipping nurses with current and proper training programs will
remove a considerable barrier associated with the lack of proper knowledge and skills in
preventing PUs (Padula, 2019). The improvement in nursing staff knowledge in dealing with
pressure ulcers will play a significant role in reducing the prevalence of PUs in the region’s
nursing facilities. The training will be completed within one week in the nursing facility. The
training aims to improve the PUs prevention and care management significantly because nurses
will have familiarized themselves with all the processes critical to mitigating the development of
The best way of preventing PUs is by identifying the risks associated with the health
problem. In this case, risk assessment is a critical intervention that will ensure that nursing staff
in all facilities treat and attend to patients effectively. A proper assessment will create better
outcomes and reduce PUs incidents because nurses will follow proper guidelines for timely
check-ups and repositioning. PUs are mainly caused by pressure on the skin of an immobile
patient, and regular repositioning of the patients will prevent the injuries from developing. An
improved care is delivered effectively when the risk assessment process is completed effectively
because proper care interventions are delivered with precision and accuracy (Lee, 2022).
Correcting all practices primarily compromised in nursing facilities is a critical milestone in
negating the prevalence of PUs in nursing facilities in Miami. When nurses establish the right
interventions for giving a proper and appropriate care, the incidence and prevalence or PUs is
expected to be improved.
Anthony, D., Alosoumi, D., & Safari, R. (2019). Prevalence of pressure ulcers in long-term care:
a global review. Journal of wound care, 28(11), 702-709.
Au, Y., Holbrook, M., Skeens, A., Painter, J., McBurney, J., Cassata, A., & Wang, S. C. (2019).
Improving the quality of pressure ulcer management in a skilled nursing facility.
International Wound Journal, 16(2), 550-555.
Cowan, L. J., Ahn, H., Flores, M., Yarrow, J., Barks, L. S., Garvan, C., & Stechmiller, J. (2019).
Pressure ulcer prevalence by the level of paralysis in patients with spinal cord injury in
long-term care. Advances in Skin & Wound Care, 32(3), 122-130.
Kim, J. Y., & Lee, Y. J. (2019). A study on the nursing knowledge, attitude, and performance
towards pressure ulcer prevention among nurses in Korean long‐term care facilities.
International wound journal, 16, 29-35
Lavallée, J. F., Gray, T. A., Dumville, J. C., & Cullum, N. (2019). Preventing pressure injury in
nursing homes: developing a care bundle using the Behaviour Change Wheel. BMJ Open,
9(6), e026639.
Lee, Y. N., Kwon, D. Y., & Chang, S. O. (2022). Bridging the Knowledge Gap for Pressure
Injury Management in Nursing Homes. International journal of environmental research
and public health, 19(3), 1400.
Padula, W. V., Chen, Y. H., & Santamaria, N. (2019). Five‐layer border dressings as part of a
quality improvement bundle to prevent pressure injuries in US skilled nursing facilities
and Australian nursing homes: a cost‐effectiveness analysis. International Wound
Journal, 16(6), 1263-1272.
Saleh, M. Y., Papanikolaou, P., Nassar, O. S., Shahin, A., & Anthony, D. (2019). Nurses’
knowledge and practice of pressure ulcer prevention and treatment: an observational
study. Journal of tissue viability, 28(4), 210-217.
Stone, A. (2020). Preventing pressure injuries in nursing home residents using a low-profile
alternating pressure overlay: a point-of-care trial. Advances in skin & wound care,
33(10), 533-539.
Yap, T. L., Alderden, J., Kennerly, S. M., Horn, S. D., Rowe, M., & Sabol, V. K. (2021). To
Turn or Not to Turn: Exploring Nurses’ Decision-Making Processes Concerning Regular
Turning of Nursing Home Residents. Gerontology and Geriatric Medicine, 7,
Significance and Schedule of the Practice Change
Significance and Schedule of the Practice Change
The project entails diverse preventive interventions applicable and efficient in reducing
pressure injury incidents in nursing homes and facilities. The practice change entails diverse
activities tailored to care bundles and other improvements, such as training program that will
reduce pressure on the patients’ contact surface. The project entails training nurses on improving
their assessment and monitoring practices and includes coordinated, well-documented, and
supervised repositioning after the stipulated period (Saleh et al., 2019). The stakeholders, in this
case, include the whole nursing fraternity, such as nurses, managers, and shareholders. Pressure
ulcers are one of the most significant problems that nursing facilities face because it declines the
health status of patients and escalates the costs of care. The project has developed interventions
aiming to improve the quality of care and reduce the high costs associated with managing PUs
(Saleh et al., 2019). In this case, nursing staff faces the blame for the escalating incidents of bed
sores in nursing homes. The project intends to offer a strategic training program to nursing staff
to improve their knowledge and skills in preventing bed sores.
Significance of the Project to Stakeholders and Nursing Homes
The institution will support the practice change because they Are always trying to find a
way to better improve the care they provide to their patients, and this is important for them due
to the escalating rate of developing bed sores. Therefore, they will be open to any chance they
get that will improve their quality of care and significantly reduce the development of pressure
injuries. The practice change entails interventions approved by evidence-based practice, enabling
nursing homes to prevent the development of PUs without huge investments (Yap, 2019).
Training nurses on how to exercise effective assessment and monitoring and maintain a healthy
skincare routine require a few days because they are versed with the concept, and they need the
connection between the concepts and their efficacy in preventing PUs. The stakeholders will
have a great chance to improve the institutions’ performance and productivity if they adopt the
proposed practice change because they will save millions after reducing the PUs incidents. The
long-term benefits will be rewarding because they will provide reduced hospital stay, work
overload, and minimal medical supplies needed to manage PUs.
Projected Schedule of the Project
The project is projected to take 4 weeks, and the first 2 days will entail of providing a
questionnaire to facility staff (participants), that consists of a self-assessment on PU prevention,
then training the nursing staff (participants) on modern PUs prevention practices supported by
evidence-based resources. The next phase will entail putting the skills and knowledge obtained in
the training sessions to practice and monitoring their efficacy levels (Seo, 2020). It will last for
three weeks, and the researcher will work with the nursing homes’ stakeholders and nursing staff.
In this case, the phase will have nurses and nursing homes’ leadership members in a randomized
control trial that will measure or evaluate the efficacy level of the imparted skills and knowledge
on the nursing staff. The last phase will take one day, and it will entail retaking the questionnaire
for self-evaluation on prevention of PUs.
Saleh, M. Y., Papanikolaou, P., Nassar, O. S., Shahin, A., & Anthony, D. (2019). An
observational study of nurses’ knowledge and practice of pressure ulcer prevention
and treatment. Journal of tissue viability, 28(4), 210-217.
Seo, Y., & Roh, Y. S. (2020). Effects of pressure ulcer prevention training among nurses in
long-term care hospitals. Nurse education today, 84, 104225.
Yap, T. L., Kennerly, S. M., & Ly, K. (2019). Pressure injury prevention: outcomes and
challenges to use of resident monitoring technology in a nursing home. Journal of
Wound, Ostomy, and Continence Nursing, 46(3), 207.

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