Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

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Objective: Evaluate whether the initiation of incontinence care education can improve pressure injury knowledge by an average of 5% in post-test scores over 1 month. Design: Theoretical Framework: Lewin’s Three-Step Model for Planned Change and Evidence-Based Practice Improvement Model. Setting/Local Problem: A 20-bed acute care geriatric unit in a large metropolitan hospital in middle Tennessee with inappropriate use of incontinence management products. Participants: Nurses and nursing assistants employed at the project site. Intervention/Measurements: An educational tool was developed to improve knowledge on pressure injury prevention through incontinence management. A pre-test and post-test were conducted immediately before and after educational tool was viewed to measure knowledge gained from the tool. Results: Out of the 43 nurses and nursing assistants encouraged to participate in the intervention, there were nine responses. All of the responses were included in the data analysis because all of the responses were valid. The pre-test results were shockingly high, demonstrating the importance the project site places on pressure injury prevention. The average pre-test score was 93.3% and the average post-test score was 94.4%. Although it is reassuring that overall scores improved after reading the educational material, the difference in scores was minimal. This information suggests that the pre-test was too easy for the knowledge level of participants. This information can be utilized for future PDSA cycles. The results were not statistically significant, with a p-value of 0.106. Despite a lack of significance between pre and post-test scores, three respondents selected “strongly agree’ and five selected ‘agree’ for the 11th question, “I will change my practice based on what I learned”. The final respondent selected ‘neutral’ for this question. The last short answer question regarding what barriers staff members face to provide appropriate skin care also delivered important information. Although four respondents did not answer the question, all five of the respondents who did answer this question included staff shortage as one of the reasons that appropriate skin care is not provided. Conclusion: With only a 1.1% different between average pre-test and post-test score, it is evident that most respondents knew the correct answers before engaging in the education. For future PDSA cycles, it would be beneficial to modify the pre and post-test questions to a higher difficulty level. The difficulty of pre and post-test needs to match the advanced knowledge of the respondents. It could be hypothesized that participants in the intervention understand how to appropriately manage incontinence, but implementing those practices at the bedside is difficult. Future PDSA cycles might focus on motivating staff to implement evidence-based practices at the bedside. One way to do so is an educational tool that uses case studies that resemble patients frequently cared for at the project site. By centering the tool on scenarios similar to what the employees experience, it may be easier to apply what is learned. Additionally, it may be beneficial to remove briefs from the supply room. Decreasing accessibility to briefs may be the most beneficial way of encouraging nurses and nursing assistants to implement evidence-based practice at the bedside.

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