Preventing Pressure Injuries by Turning and Repositioning

Subject:	Nursing
Pages:	23
Words:	6286
Reading time:	30 min
Study level:	Bachelor

Introduction to the Project

Pressure injuries or hospital-acquired pressure ulcers (HAPUs) are a significant issue in the healthcare industry. It is so because they “affect over 2.5 million individuals resulting in 60,000 deaths” in the United States every year (Padula et al., 2019, p. 132). These health problems occur when force is being continuously applied to an individual’s skin. As a result, older people and hospital patients who experience movement restrictions are often subject to HAPUs. That is why this issue requires improvement since this global concern is harmful and deteriorates public health.

The given project is not unique in addressing the issue of pressure injuries. However, it is significant since it tries to address the need that is found in the literature. While Padula et al. (2019) have indicated the spread of the condition, Padula and Delarmente (2019) also highlight its financial burden. Even though multiple scholarly works, including the ones by Gray and Giuliano (2018), Latimer, Gillespie, and Chaboyer (2017), and others, state that the problem is preventable, its incidence rate remains high. That is why the project addresses the need to find an effective intervention to protect patients from pressure injuries.

The given prospectus is an initial stage for developing the further direct practice improvement (DPI) project. Consequently, it contains essential points that are useful for understanding why and how the DPI project should be performed. Firstly, the problem statement, the purpose of the project, and the clinical question are mentioned to understand the problem and its significance. Secondly, the prospectus comments on methodology, project design, data collection, and data analysis procedures. These points are significant since they reveal whether a suitable scientific approach is utilized to address the issue under consideration. Thirdly, the literature review is offered to highlight how other scholarly articles view the problem.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Introduction This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (Three or four paragraphs or approximately one page)	3
Direct Practice Improvement Project is introduced.	3
Describe how the project extends prior evidence or fills a “need” or “gap” from the current literature.	3
The discussion provides an overview of what is contained in the prospectus	3
NOTE: This Introduction section elaborates on Point #1(the Topic) from the 10 Strategic Points. This Introduction section provides the foundation for the Introduction section in Chapter 1 of the Proposal.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Background of the Problem

The information above has already demonstrated that HAPUs are a significant healthcare problem in the US. The medical industry has to deal will millions of patients with pressure injuries, which results in an essential financial burden. For example, Padula and Delarmente (2019) claim that HAPU costs are approximately $26.8 billion in the US. That is why it is not surprising that such an impactful issue has a long history.

Pressure injuries were creating challenges in the 20^th century when J. D. Shea developed a pressure injury classification problem in 1975 (Edsberg et al., 2016). In 1989, the National Pressure Ulcer Advisory Panel (NPUAP) established its 4-stage qualification, and its revised version is applied today (Edsberg et al., 2016). This step contributed to the fact that the healthcare industry started addressing the problem more efficiently.

Multiple scholarly articles prove the idea that HAPUs are preventable. It refers to the works by Gray and Giuliano (2018), Latimer et al. (2017), Lin, Wu, Song, Coyer, and Chaboyer (2020), and others. This approach results in essential benefits that relate to the fact that HAPU incidence has decreased. For example, Rondinelli et al. (2018) argue that pressure injury “rates fell from 40.3 to 30.9 per 1,000 discharges between 2010 and 2014” in the US (p. 17).

However, Rondinelli et al. (2018), Lemmer et al. (2019), and others stipulate that the existing efforts are not sufficient because the problem has not been eliminated. It means that the healthcare industry does not have an approach that could protect patients from HAPUs. Consequently, the given prospectus focuses on the need to find a more effective intervention that would reduce the incidence of pressure injuries among the population. The further section will present the problem statement of the given project.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Background of the Problem The background section explains both the history of and the present state of the problem and project focus. The recommended length for this section is two or three paragraphs or one page.	3
Identifies the “need” or “defined gap” that will lead to the problem statement in the following section. Citations from the literature in the last 5 years describe the problem as a current “need” or “gap” for further research.	3
This section provides an overview of the history of and present state of the problem and project focus.	3
ALIGNMENT: The problem statementfor the Direct Practice Improvement Project will be developed from and justified by the “need” or “defined gap” that is described in this section and supported by the Literature.
NOTE: This Background of the Problemsection uses information from Point #2 (Literature Review) in the 10 Strategic Points.This Background of the Problemsection becomes the Background of the Projectin Chapter 1 in the Proposal. It is then expanded to develop the comprehensive Background to the Problem section in Chapter 2 (Literature Review) in the Proposal.
NOTE: When writing this section, ensure it has a logical flow, as well as, uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Problem Statement

It is not known if or to what degree the implementation of turning and repositioning patients every two hours impacts the HAPU prevalence rate when compared to doing so once in four hours among hospitalized patients with a Braden Scale of less than 15 in medical inpatient units in Coney Island Hospital over six months.

The proposed problem is of significance, and scientific evidence proves this claim. Firstly, the issue of HAPUs is of a nationwide scale because millions of people suffer from them every year (Padula et al., 2019). Secondly, the issue’s financial burden is also fundamental, meaning that specific actions are necessary to improve the situation (Padula & Delarmente, 2019). Thus, the preventable nature of pressure injuries and previous success with mitigating the problem justify the importance of addressing the issue under analysis and allow articulating the purpose.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Problem Statement This section includes the problem statement, the population affected, and how the project will contribute to solving the problem. The recommended length for this section is two or three paragraphs.	3
This section states the specific problem for investigation by presenting a clear declarative statement that begins with “It is not known if and to what degree/extent…,” or “It is not known how/why and….”	3
Clearly describes the magnitude and importance of the problem, supporting it with citations from the literature.	3
ALIGNMENT: The problem statement is developed from and justified by the “need” or “defined gap” defined by the Literature that is discussed in the Background to the Problemsection above.
NOTE: This section elaborates on Points #3 (Problem Statement) from the 10 Strategic Points. This section becomes the foundation for the Problem Statement section in Chapter 1(and other Chapters where appropriate) in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format

Purpose of the Project

The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of turning and repositioning patients every two hours impacts the HAPU prevalence rate when compared to doing so once in four hours among hospitalized patients with a Braden Scale of less than 15 in medical inpatient units in Coney Island Hospital over six months.

The independent variable of turning and repositioning will be measured by identifying the frequency of these interventions; turning and repositioning every two, three, and four hours are used today (Courvoisier, Righi, Béné, Rae, & Chopard, 2018). The independent variable of the HAPU incidence rate will be measured by comparing the number of pressure ulcers before and after the intervention. These variables form the basis of the clinical question that guides the project.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Purpose of the Project The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the proposed project will contribute to the field. The recommended length for this section is one paragraph.	3
Presents a declarative statement: “The purpose of this project is….” that identifies the project design, population, variables (quantitative) to be investigated, and geographic location.	3
ALIGNMENT: The Purpose Statement includes: Project Methodology, Project Design, and Problem Statementfrom the previous sections. It also includes the target population, which should be of enough size to provide a large enough sample to complete the project and provide significant results.
NOTE: This section elaborates on Points #8 (Purpose Statement) in the 10 Strategic Points. This section becomes the foundation for the Purpose of the Project in Chapter 1 of the Proposal.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Clinical Question(s)

The clinical question guiding the whole DPI project is as follows.

Q1: To what degree does the implementation of turning and repositioning patients every two hours impacts the HAPU prevalence rate when compared to doing so once in four hours among hospitalized patients with a Braden Scale of less than 15 in medical inpatient units in Coney Island Hospital over six months? Thus, turning and repositioning patients are an independent variable, while the HAPU incidence rate is a dependent one.

Variable 1: Turning and repositioning patients (independent).
Variable 2: HAPU incidence rate (dependent).

According to the information above, the prospectus deals with independent and dependent variable types, implying that the nominal level of measurement is required to measure each of them and answer the clinical question. This information will further contribute to advancing scientific knowledge, which will be discussed below.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Clinical question(s) This section narrows the focus of the project and specifies the clinical questions to address the problem statement. Based on the clinical questions, it describes the variables. (Two or three paragraphs). The recommendation is a minimum of one clinical question, along with related variables, which are required for a quantitative project. Put the Clinical Questions in the Table in Appendix B	3
Quantitative Designs: States the clinical question(s) the project will answer, identifies the variables.	3
ALIGNMENT: The clinical questions are based on both the Problem Statement and Theoretical Foundation model(s) or theory(s). There should be no clinical questions that are not clearly aligned to the Problem Statement.
NOTE: This section elaborates on Points #4 (Clinical Questions) & #6Variables)from the 10 Strategic Points. This section becomes the foundation for the clinical question(s) section in Chapter 1 in the Proposal.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Advancing Scientific Knowledge

The prospectus advances scientific knowledge associated with the implementation of turning and repositioning to decrease the HAPU incidence rate. There is a need to find more effective interventions to reduce the HAPU incidence in the healthcare industry because this issue is preventable but is not eliminated (Gray & Giuliano, 2018; Latimer et al., 2017; Lin et al., 2020; Rondinelli et al., 2018). The project will utilize a scientific approach to determine whether an increased frequency of turning and repositioning can meet the stipulated purpose.

The project is built on the theory of planned behavior. Icek Ajzen developed this model, and he identified that specific factors could affect changes in individual behavior. In other words, behavioral control can become a predictor that a person makes the correct actions and decisions (Ajzen, 1985). In this project, the correct actions are turning and repositioning movements every two hours. Thus, the given project will advance the theory by highlighting whether it is capable of leading to better health outcomes regarding pressure injuries. The further section will comment on the project’s significance to people and the medical industry.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Advancing Scientific Knowledge This section specifically describes how the project will advance population health outcomes on the topic. It can be a small step forward in a line of the current project, but it must add to the current body of knowledge in the literature. It identifies the gap orneedbased on the current literature and discusses how the project will address that gap or need. This section summarizes the Theoretical Foundations section in Chapter 2 (Two or three paragraphs)	3
This section clearly identifies the gap or need in the literature that was used to define the problem statement and develop the clinical questions.	3
This section describes how the project will address the gap or identified need in the literature.	3
This section identifies the theory or model upon which the project is built.	3
This section describes how the project will advance the theory or model upon which the project is built.	3
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	3

Significance of the Project

The project will significantly contribute to the current literature on the topic. It is expected that the DPI project will offer useful information to address the financial burden of HAPUs, which is discussed by Padula and Delarmente (2019). Then, a massive body of literature that focuses on the preventable nature of pressure ulcers will also be enriched.

The project will stand together with the articles by Gray and Giuliano (2018), Latimer et al. (2017), Lin et al. (2020), and others regarding this topic. Finally, the project will add to Rondinelli et al. (2018) and Lemmer et al. (2019) since it comments on effective interventions to reduce the HAPU incidence rate.

The project will also contribute to the literature on the theory of planned behavior. It relates to the fact that the project will answer whether specific measures of behavior control can promote the expected behavior, which refers to turning and repositioning every two hours. In other words, it will be shown whether Ajzen’s (1985) approach is a useful way to improve health outcomes and prevent HAPUs.

The project is also significant because addressing the problem will have practical value. On the one hand, the project has the potential to reduce healthcare expenditures on pressure ulcer management (Padula & Delarmente, 2019). It means that the government will have the opportunity to allocate these funds to address other essential issues.

On the other hand, the project will result in better public health. It refers to the fact that mitigating the problem will mean that more than two million people will not suffer from HAPUs every year (Padula et al., 2019). Thus, it is challenging to overestimate the significance of the project for the healthcare industry and population. It is necessary to explain what methodology can lead to this result.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Significance of the Project This section identifies and describes the significance of the project and the implications of the potential results based on the clinical questions and problem statement. It describes how the project fits within and will contribute to the current literature or the clinical site practice. It describes potential practical applications from the project. The recommended length for this section is three or four paragraphs.	3
Describes how the proposed project will contribute to the literature, relating it specifically to other studies from the Background to the Problem and Problem Statement above.	3
Describes how the proposed project will contribute to the literature on the selected theory(s) or model(s) that comprise the Theoretical Foundation for the project.	3
Describes how addressing the problem will have practical value for the real world, considering the population, community, and/or society.	3
ALIGNMENT: Part 1 is based on specific, previous studies from the Background to the Problemand Problem Statementssections above and identifies how this project will contribute to that Literature. Part 2 is based on a specific model(s), theory(s), or variables from the Theoretical Foundationssection and identifies how this project will contribute to the knowledge on those model(s) or theory(s). Part 3 reflects on potential practical applications of the project’s findings based on Literature in the field of practice.
NOTE: This section does not directly come from any section of the 10 Strategic Points. However, it does build on the Background to the Problem, Problem Statement,and Theoretical Foundationssections that are developed from the 10 Strategic Points.This section becomes the Significance of the Projectsection in Chapter 1 in the Proposal.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Rationale for Methodology

A suitable methodology is needed to ensure that the problem statement is addressed adequately. The quantitative methodology seems appropriate to identify the effects of turning and repositioning patients every two hours compared to doing so once in four hours. However, it is necessary to find scholarly sources that would justify the choice of this methodology, and the following paragraph will offer the data to cope with this issue.

Multiple sources justify the use of the quantitative methodology by highlighting its benefits. Creswell and Creswell (2018) stipulate that quantitative methods are recommended for DPI projects because of their clinical relevance and feasibility. Furthermore, Rutberg and Boukidis (2018) admit that a quantitative approach is suitable if a lack of research exists or the project can “make a meaningful impact on patient care” (p. 210). Thus, the method under consideration is the best approach to answer the clinical question guiding the project.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Rationale for Methodology This section clearly justifies the methodology of the learner plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. It uses citations from textbooks and articles on research methodology and/or articles on related studies. The recommended length for this section is two to three paragraphs, and the completion of Table 1 (quantitative) in Appendix B.	3
Identifies the specific project methodology for the project	3
It justifies the project’s methodology to be used for the project by discussing why it is the best approach for answering the clinical question and addressing the problem statement. Uses citations from original sources in the literature or textbooks on the specific research methodology to support the arguments.	3
ALIGNMENT: The selected methodology should be justified based on the Problem Statementand ClinicalQuestions.
NOTE: This section elaborates on the methodology part of Point #7(Methodology and Design) in the 10 Strategic Points. This section becomes the foundation for the Project Methodology in Chapter 1 of the Proposal and the basis for developing Chapter 3, Project Methodology.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format

Nature of the Project Design

A quasi-experimental design is chosen to address the identified problem and answer the clinical question. This design implies that an intervention, turning and repositioning patients every two hours, with a control group will be implied, but randomization will be absent. Rutberg and Boukidis (2018) state that this approach is suitable to compare the results of two groups to find whether the intervention results in statistically significant results. A descriptive design is not appropriate because it describes a phenomenon or analyzes its long-term development (Doyle, McCabe, Keogh, Brady, & McCann, 2020).

In turn, an experimental design denotes that intervention should be implemented in a laboratory setting and requires randomization (Routberg & Boukidis, 2018). Consequently, the two are not appropriate options for the DPI project, while the quasi-experimental approach analyzes the effectiveness of the intervention under real-life conditions. A relatively large sample (at least 100 individuals) is needed to have a sufficient number of hospitalized patients in both intervention and control groups. The data on the sample is collected to assess the participants’ health regarding the presence of HAPUs.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Nature of the Project Design This section describes the specific research design to answer the clinical questions and why this approach is used. It describes the project sample as well as the process that will be used to collect the data on the sample. The recommended length for this section is one paragraph and completion of Table 1 (quantitative) in Appendix B.	3
Identifies the specific type of project design for the project.	3
Discusses why the selected design is the best design to address the clinical questions as compared to other designs.	3
This section briefly describes the specific sample and the data collection procedure to collect information on the sample. Briefly describes how the design supports the intervention and solution to the practice problem	3
ALIGNMENT: The selected Project Design should be justified based on the clinical questions as well as the variables. It should also be aligned with the selected Project Methodology.
NOTE: This section also elaborates on the Design part of Point #7 (Methodology and Design) in the 10 Strategic Points. This section provides the foundation for Nature of the Project Design in Chapter 1.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Sources of Data

According to the purpose of the project, it is necessary to ensure that the intervention group is turned and repositioned every two hours, while members of the control group change their positions once in four hours. The E-scale, a freely available bed weight monitoring system with load cells placed under the legs of a bed, can be used to monitor and detect postural movements in bed (Duvall, Karg, Brienza, & Pearlman, 2019).

Regarding the HAPU presence, the project is going to analyze the participants’ electronic health records (EHRs). Consequently, it is necessary to receive permission from the clinical site administration to access its database. The participants should also provide written consent to allow the researcher to use their personal information. To ensure that the data are protected, the researcher will only access it without downloading it. A simple written form will be used to note whether the participants have HAPUs; the chief researcher only will have access to this form.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Instrumentation or Sources of Data Describes, in detail, all data collection instruments and/or sources of data (tests, questionnaires, interviews, databases, media, etc.). Discusses the specific instrument or source to collect data for each variable. The recommended length for this section is one paragraph AND completion of Table 1 Appendix B.	3
Identifies and describes the types of data that will be collected to answer each Clinical Question. Identifies the data that will be collected for each variable	3
Identifiestools, instruments, or databases to be used to collect the data (e.g., standardized tests, surveys, and databases. Identify the name of the specific “validated” and “previously used in quantitative research” survey or data source to be used to collect data for each variable, providing a citation for the instrument or data source.	3
ALIGNMENT: Aligns with the Clinical Questions previously described in theClinical Questions and Variables section above. Identifies, describes, and namesthe type of numerical data and specific data collection instrument or source that will be used for each variable and group in a quantitative project.
NOTE: This section elaborates on Point #9 (Data Collection) from the 10 Strategic Points. This information is summarized high level in Chapter 1 in the Proposal the Project Design for the Project section. This section provides the foundation for the Instrumentation section in Chapter 3.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Data Collection Procedures

The project focuses on the hospitalized urban population with the Braden Scale of less than 15 in Brooklyn. Among this group, it is necessary to recruit at least 100 individuals because two 50-member groups can generate sufficient evidence to identify whether the intervention leads to statistically significant results. Persons with the Braden Scale of 16 and more and pediatric patients are note recruited. The individuals should express free consent to participate in the project, and it is up to them to choose whether they will be in an intervention or a control group.

The process of performing the project implies a few significant steps. Firstly, it is necessary to receive written approval from the site and Grand Canyon University institutional review board (IRB). Secondly, the sample population should be contacted to recruit the sample size. The contacted individuals are free to decide whether they will participate in the project, which protects their rights and well-being.

The E-scale is necessary to ensure that the fixed turning and repositioning frequencies are followed, while the retrieval of EHRs is essential to analyze the presence of HAPUs. Data security is preserved since the chief researcher is not going to download the patients’ information. Instead, the data will be copied in a written format, and the chief researcher will only have access to it.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Data Collection Procedures This section details the entirety of the process used to collect the data. It describes each step of the data collection process in a way that another investigator could replicate the project. NOTE:To conduct the project as described, the student must receive written approval from the site, site institutional review board (IRB) (if applicable, and Grand Canyon University IRB approval. Ensure the person providing approval is authorized by the organization to grant approval for your project. Do not assume your organization will allow you to collect data since many organizations do not allow research within the organization. The recommended length for this section is two paragraphs.	3
Defines the target population and the expected sample size, which comprises the people or organizations being studied, as defined in the problem statement. Justify why the target population and expected sample size (final number of people or organizations within the project for which data will be collected) is large enough to produce statistically significant results	3
This section describes the procedures for project sample recruitment, sample selection, and assignment to groups (if applicable).	3
It provides an overview of the proposed step-by-step procedure to collect data using the tools, instruments, or databases from the section above. Includes the steps (e.g., obtaining initial informed consent from participating organization; IRB review; sample selection; groupings; protecting rights/well-being; maintaining data security; sample recruitment; data collection instruments and approaches; field testing instruments; notifying participants; collecting the data, etc.) in a way another learner can replicate the project. Steps may be provided in a list format.	3
ALIGNMENT: Shows the steps and approaches to collect data for each and every data source identified in the Instrumentation or Sources of Data section. Defines the sample as the set of people or organizations being studied for which data will be collected. The sample size must be correct for the type of design selected to get statistically significant results
NOTE: This section elaborates on Points #5 (Sample and Location) and #9 (Data Collection) in the 10 Strategic Points. This section provides the foundation for the Data Collection Proceduressection in Chapter 3 in the Proposal.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Data Analysis Procedures

Appropriate statistical tests are necessary to identify the statistical significance of the project results. Descriptive statistics is required to analyze the sample size features, while inferential statistics deals with the dependent variable. Since the number of HAPUs is a nominal level, a non-parametric test is required (Creswell & Creswell, 2018). For this project, the Chi-square test of independence is suitable since it tests the difference in proportions in two independent groups.

Before the intervention, the participants’ personal information is collected and synthesized to generate descriptive statistics. Over six months, the participants’ EHRs are accessed to find the number of HAPUs. These figures are then used to conduct the Chi-square test of independence to identify whether the intervention has resulted in a statistically significant difference. Consequently, these easy steps form the basis of the data analysis procedures of the given project.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Data Analysis Procedures This section describes how the data were collected for each variable. It describes the type of data to be analyzed, identifying the descriptive, inferential, and/or non-statistical analyses. Demonstrates that the data analysis is aligned to the specific project design. The recommended length for this section is two to three paragraph AND completion of Table 1 (quantitative)
Describes the analysis to examine each stated clinical question and describes the analyses, including the inferential and/or descriptive statistics to be completed.
This section describes how the raw data were organized and prepared for analysis.
This section provides a detailed, step-by-step description of the procedures used to conduct the data analysis, including statistical and nonstatistical analysis.
ALIGNMENT: Quantitative projects, there is a clear and distinct alignment between each variable, data to be collected, and instrument or data source.
NOTE: This section elaborates on Point #10 (Data Analysis) from the 10 Strategic Points.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Ethical Considerations

The given project addresses all the possible ethical considerations to avoid any problems regarding the participants’ rights and data security. The approval and permissions from the clinical site and the institute’s IRB are received. It means that the site explicitly authorizes and approves the project. The patients’ data are protected because the chief researcher only accesses them, eliminating any confidentiality issues. Ethical considerations are also addressed because the recruited individuals express written and voluntary consent to participate in the project.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Ethical Considerations This section discusses the potential ethical issues surrounding the project, as well as how human subjects and data will be protected. It identifies how any potential ethical issues will be addressed. The recommended length for this section is one paragraph.	3
Discusses potential ethical concerns that might occur during the data collection process.	3
Provide a discussion of ethical issues related to the project and the sample population of interest.	3
Describes how the identities of the participants in the project and data will be protected. This section addresses anonymity, confidentiality, privacy, lack of coercion, informed consent, and potential conflict of interest.	3
Describes subject recruiting, informed consent, and site authorization processes	3
ALIGNMENT: Ethical considerations are clearly aligned with and relate directly to the specific Data Collection Procedures. This section also identifies ethical considerations related to the target population being observed and organization or location, as described in the Purpose Statement section.
NOTE: This section does use information from any of the 10 Strategic Points.

Literature Review

The topic of HAPUs is not new to the research field, meaning that multiple articles address the issue. That is why it is reasonable to analyze the existing scholarly resources to identify how the problem is addressed. The given chapter will comment on the theoretical foundations of the project and present the literature review on the topic, while the findings are synthesized into themes and subthemes.

Theoretical Foundations/Conceptual Framework

The project focuses on the theory of planned behavior, which was developed by Icek Ajzen. The seminal work stipulates that specific factors could affect changes in individual behavior, meaning that behavioral control can become a predictor that a person makes the correct actions and decisions (Ajzen, 1985). In this project, the correct actions are turning and repositioning movements every two hours. Thus, the given project will advance the theory by highlighting whether it is capable of leading to better health outcomes regarding pressure injuries.

Review of the Literature

The Role of Turning and Repositioning in Managing HAPUs. Atkinson and Cullum (2018) state that this intervention can be used here.

Effectiveness of Turning and Repositioning

Mäki-Turja-Rostedt, Stolt, Leino-Kilpi, and Haavisto (2019) show that the intervention is effective. Describe the clinical question(s), sample, method, and findings of this project.

Turning and Repositioning Intervals

Courvoisier et al. (2018) state that 2-hourly intervals are more effective than 4-hourly ones, while Tayyib and Coyer (2016) insist that no difference is present.

Repositioning Patients with Other Health Conditions

Chitambira and Evans (2018) claim that repositioning stroke patients is effective.

Turning and Repositioning with Other Interventions. Additional options can improve the effectiveness of the intervention under analysis (Gunningberg & Carli, 2016).

Continuous Bedside Pressure Mapping (CBPM)

Gunningberg and Carli (2016) emphasize the CBPM effectiveness, while Gunningberg, Sedin, Andersson, and Pingel (2017) deny this claim

Specific Mattresses and Pillows

Jiang et al. (2020) claim that viscoelastic foam and air pressure redistribution mattresses increase the turning and repositioning effectiveness.

Electronic Devices

Pickham et al. (2018) indicate that wearable sensors reduce HAPU rates.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Theoretical Foundations and/or Conceptual Framework This section identifies the theory, theories, or model(s) that provide the foundation for the project. This section should present the theory, theories, or models(s) and explain how the problem under investigation relates to the theory or model. The theory, theories, or models(s) guide the clinical questions and justify what is being measured (variables) as well as how those variables are related. Review of the Literature This section provides a broad, balanced overview of the existing literature related to the proposed project topic. It describes the literature in related topic areas and its relevance to the proposed project topic findings, providing a short one-two sentence description of each theme/topic and identifies its relevance to the project topic supporting it with at least one citation from the literature.	3
Theoretical Foundationssectionidentifies the theory, theories, and model(s) relevant to the variables. This section should explain how the project topic or problem coming out of the “need” or “defined gap” in the Background to the Problemsection relates to theory, theories, and model(s) (One paragraph)	3
Review of the Literature Themes/Topics section: This section lists the major themes or topics related to the project topic. It provides a short one-two sentence description of each theme/topic and identifies its relevance to the project topic supporting it with at least one citation from the literature. (One or two sentences per theme/topic).	3
ALIGNMENT: The Theoretical Foundationsmodels and theories need to be related to and support the problem statement or project topic. The sections in the Review of the Literatureare topical areas needed to understand the variables/groups (quantitative) to select the design needed to address the Problem Statement; to select surveys or instruments to collect information on variables/groups; to define the population and sample for the project; to describe key topics related to the project topic, etc.
NOTE: The two parts of this section use information from the 10 Strategic Points.
NOTE: When writing this section, ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.

Summary

The chapter has demonstrated that HAPUs are preventable (Mäki-Turja-Rostedt et al., 2019; Gunningberg and Carli, 2016; and others. The presence of contradictory findings regarding the effectiveness of different turning and repositioning techniques justifies the need to conduct a quantitative, quasi-experimental study to test this issue. The theory of planned behavior is applicable because it states that control measures, the E-scale, can lead to better health outcomes.

Thus, the project advances the use of the theory in addressing HAPUs. Gunningberg and Carli (2016) justify the use of a quantitative methodology, Gunningberg et al. (2017) focus on health records, while Aljezawi and Tubaishat (2018) support the investigation of hospitalized patients. Finally, these literature findings demonstrate that the given DPI project is valuable since it is going to address a significant topic in the research field.

Criteria (Required Components)	Learner Self-Evaluation Score (0-3)
Summary This section restates what was written in the section and provides supporting citations for key points. It synthesizes the information from the chapter using it to define the “gaps” in or “evidence-based practice needs” from the literature, the theories or models to provide the foundation for the project, the problem statement, the primary clinical question, the methodology, the design, the variables or phenomena, the data collection instruments or sources, and population.	2
This section synthesizes the information from all the prior sections in the Review of Literature and uses it to define the key strategic points for the project. This section summarizes the gaps and needs in the background and introduction and describes how it informs the problem statement. This section identifies the theories or models and describes how they inform the clinical questions. This section uses the literature to justify the design, variables or phenomena, data collection instruments or sources, and answer the clinical questions on your selected intervention protocol, clinical setting, and patient population.be evaluated.	2
This section builds a case for the project in terms of the value of the project.	2
This section explains how the current theories, models, and topics related to the DPI project will be advanced through your intervention and outcomes.	2
This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.	3

References

Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action control: From cognition to behavior (pp. 11-39). New York, NY: Springer.

Atkinson, R. A., & Cullum, N. A. (2018). Interventions for pressure ulcers: A summary of evidence for prevention and treatment. Spinal Cord, 56, 186-198.

Chitambira, B., & Evans, S. (2018). Repositioning stroke patients with pusher syndrome to reduce incidence of pressure ulcers. British Journal of Neuroscience Nursing, 14(1), 16-21.

Courvoisier, D. S., Righi, L., Béné, N., Rae, A.-C., & Chopard, P. (2018). Variation in pressure ulcer prevalence and prevention in nursing homes: A multicenter study. Applied Nursing Research, 42, 45-50.

Creswell, J.W. & Creswell, J.D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5^th ed.) Thousand Oaks: CA. Sage Publications.

Doyle, L., McCabe, C., Keogh, B., Brady, A., & McCann, M. (2020). An overview of the qualitative descriptive design within nursing research. Journal of Research in Nursing, 25(5), 443-455.

Duvall, J., Karg, P., Brienza, D., & Pearlman, J. (2019). Detection and classification methodology for movement in the bed that supports continuous pressure injury risk assessment and repositioning compliance. Journal of Tissue Viability, 28(1), 7-13.

Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing, 43(6), 585-597.

Gray, M., & Giuliano, K. K. (2018). Incontinence-associated dermatitis, characteristics, and relationship to pressure injury. Journal of Wound, Ostomy, and Continence Nursing, 45(1), 63-67.

Gunningberg, L., & Carli, C. (2016). Reduced pressure for fewer pressure ulcers: Can real-time feedback of interface pressure optimize repositioning in bed? International Wound Journal, 13(5), 774-779.

Gunningberg, L., Sedin, I.-M., Andersson, S., & Pingel, R. (2017). Pressure mapping to prevent pressure ulcers in a hospital setting: A pragmatic randomized controlled trial. International Journal of Nursing Studies, 72, 53-59.

Jiang, Q., Liu, Y., Yu, H., Song, S., Li, G., Liu, H., … & Wang, J. (2020). A multicenter, comparative study of two pressure-redistribution mattresses with repositioning intervals for critical care patients. Advances in Skin & Wound Care, 33(3), 1-9.

Latimer, S., Gillespie, B. M., & Chaboyer, W. (2017). Predictors of pressure injury prevention strategies in at-risk medical patients: An Australian multi-center study. Collegian, 24(2), 155-163.

Lemmer, D. P., Alvarado, N., Henzel, K., Richmond, M. A., McDaniel, J., Graevert, J., … Bogie, K. M. (2019). What lies beneath: Why some pressure injuries may be unpreventable for individuals with spinal cord injury. Archives of Physical Medicine and Rehabilitation. Web.

Lin, F., Wu, Z., Song, B., Coyer, F., & Chaboyer, W. (2020). The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. International Journal of Nursing Studies, 102. Web.

Mäki-Turja-Rostedt, S., Stolt, M., Leino-Kilpi, H, & Haavisto, E. (2019). Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review. Journal of Clinical Nursing, 28(13-14), 2420-2442.

Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospital-acquired pressure injurites in the United States. International Wound Journal, 16(3), 634-640.

Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2019). Value of hospital resources for effective pressure injury prevention: A cost-effectiveness analysis. BMJ Quality & Safety, 28(2), 132-141.

Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desia, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12-19.

Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-acquired pressure injury: Risk-adjusted comparisons in an integrated healthcare delivery system. Nursing Research, 67(1), 16-25.

Rutberg, S., & Boukidis, C. D. (2018). Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-212.

Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review. Worldview on Evidence-Based Nursing: Linking Evidence to Action, 13(6), 432-444.

Appendix A

10 Strategic Points Table (Use this table to complete the 10 Strategic Points document for your project.)

The 10 Strategic Points
Broad Topic Area	Broad Topic Area/Title of Project: Preventing the occurrence of pressure injuries with the help of turning and repositioning.
Literature Review	Literature Review: Background of the Problem/Gap: In the USA, pressure injuries or Hospital-Acquired Pressure Ulcers (HAPUs) “affect over 2.5 million individuals resulting in 60,000 deaths” (Padula et al., 2019, p. 132). Pressure injuries are costly to the health care system and preventable. An approach to managing hospitalized patients should be improved to reduce the ratio of this health condition. Theoretical Foundations (models and theories to be the foundation for the project): The E-scale can be used to monitor and detect postural movements in bed (Duvall et al., 2019). It is possible to use the Braden scale to identify those patients who are at risk of having pressure ulcers (Padula et al., 2019). The Likert Scale is useful to assess staff perceptions about the turn team intervention (Harmon et al., 2016). LCD screens with color-coding are used to monitor the patient’s repositioning history (Yap et al., 2019). Review of Literature with Key Organizing Themes and Sub-themes Hospital-Acquired Pressure Ulcers: HAPUs are preventable conditions, and their prevalence rates may vary from 3% to 33%, depending on external circumstances (Gray & Giuliano, 2018; Latimer et al., 2017; Lin et al., 2020). Pressure injuries can affect individuals of various groups, including pediatric (Razmus & Bergquist-Beringer, 2017) and older patients (Hultin et al., 2019; Latimer et al., 2019). Various factors contribute to the development of HAPUs, including diabetes mellitus (Cox, 2017), being 65 and more years old (Alvarez et al., 2016), and an increased length of hospital stay (Wang et al., 2020). Turning and Repositioning Effects: Gammon et al. (2016), Duvall et al. (2019), and Schutt et al. (2018) explain that self-turns and rolls are an effective strategy for hospitalized patients to avoid HAPUs. The positive outcomes of introducing turn teams are explained in the studies by Harmon et al. (2016), Cyriacks and Spencer (2019), and Barakat-Johnson et al. (2019). The articles by Joseph et al. (2019), Hall (2018), and Yap et al. (2019) explain that patients should be turned at least once in two hours to contribute to healthy blood circulation. Summary Gap/Problem: There is a need to identify how it is possible to reduce the prevalence rate of pressure injuries among hospitalized patients. Prior studies: Prior studies demonstrate that turning and repositioning are suitable options to address the issue. Quantitative application: Sources of data exist to identify to what extent turning and repositioning approaches reduce the rate of pressure injuries. Significance: Reducing the prevalence of HAPUs will contribute to better health outcomes of hospitalized patients.
Problem Statement	Problem Statement: While the literature indicates that turning and repositioning patients every two hours helps avoid pressure injuries, it is unknown whether this strategy implies a lower HAPU rate among hospitalized patients.
Clinical/ PICOT Questions	Clinical/PICOT Questions: (P) Among hospitalized patients with a Braden Scale of less than 15, can (I) turning patients every two hours, (C) compared to every four hours, (O) reduce the HAPU incidence (T)by January 2021? To what degree does the implementation of turning and repositioning patients every two hours impacts the HAPU prevalence rate when compared to doing so once in four hours among hospitalized patients with a Braden Scale of less than 15 in medical inpatient units in Coney Island Hospital over six months?
Sample	Sample (and Location): a. Location: Urban (Coney Island Hospital, Brooklyn). b. Population: hospitalized patients with Braden Scale of less than 15. c. Sample: 100 Patients d. Inclusion Criteria Hospitalized patients with Braden Scale of less than 15 can participate in the study. They can be of various genders, nationalities, and others. It is also possible to analyze participants with different health issues, including diabetes mellitus, hypertension, and other comorbidities. e. Exclusion Criteria Patients with Braden Scale of more than 16 cannot participate in the study. Furthermore, pediatric patients are not included in the present study.
Define Variables	Define Variables and Level of Measurement: Independent Variable (Intervention): Turning and repositioning approach. Dependent Variable: The HAPU incidence rate.
Methodology and Design	Methodology and Design: This project will use a quantitative methodology with a quasi-experimental design.
Purpose Statement	Purpose Statement: The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the implementation of turning and repositioning patients every two hours impacts the HAPU prevalence rate when compared to doing so once in four hours among hospitalized patients with Braden Scale of less than 15 in medical inpatient units in Coney Island Hospital over six months.
Data Collection Approach	Data Collection Approach: Once a sample is found, it should be equally divided into experimental and control groups. Representatives of the experimental groups will be turned and repositioned every two hours, while control members will experience changes once in four hours. The medical units should have a particular system that will allow nurses to monitor patient repositioning statuses through LED screens. This condition is necessary to ensure that the participants follow the study design. Over a six-month period, the participants’ health should be assessed to identify whether regular turning once in two hours has resulted in fewer pressure injuries.
Data Analysis Approach	Data Analysis Approach: Descriptive analysis will be used to identify whether the independent variable has managed to address the dependent one. It will be necessary to define HAPU percentage in the two groups and compare the values. Consequently, it is essential to apply the statistical paired t-test to determine how effective the proposed intervention is. When it comes to the sample size justification, it is better to analyze as many participants as possible to achieve the highest accuracy. It seems that 100 participants who will make two 50-member groups will be sufficient to answer the PICOT and clinical questions.
References	APA formatted sources. Alvarez, O. M., Brindle, C. T., Langemo, D., Kennedy-Evans, K. L., Krasner, D. L., Brennan, M. R., & Levine, J. M. (2016). The VCU pressure ulcer summit. Journal of Wound, Ostomy, and Continence Nursing, 43(5), 455-463. Web. Barakat-Johnson, M., Lai, M., Wand, T., & White, K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95-102. Cox, J. (2017). Pressure injury risk factors in adult critical care patients: A review of the literature. Ostomy Wound Management, 63(11), 30-43. Cyriacks, B., & Spencer, C. (2019). Reducing HAPI by cultivating team ownership of prevention with budget-neutral turn teams. Medsurg Nursing, 28(1), 48-52. Duvall, J., Karg, P., Brienza, D., & Pearlman, J. (2019). Detection and classification methodology for movements in the bed that supports continuous pressure injury risk assessment and repositioning compliance. Journal of Tissue Viability, 28(1), 7-13. Web. Gammon, H. M., Shelton, C. B., Siegert, C., Dawson, C., Sexton, E., Burmeister, C., Gnam, G., & Siddiqui, A. (2016). Self-turning for pressure injury prevention. Wound Medicine, 12, 15-18. Gray, M., & Giuliano, K. K. (2018). Incontinence-associated dermatitis, characteristics, and relationship to pressure injury. Journal of Wound, Ostomy, and Continence Nursing, 45(1), 63-67. Web. Hall, M. L. (2018). Hospital acquired pressure injury gap analysis [Master’s Project, Grand Valley State University]. Scholar Works. Harmon, L. C., Grobbel, C., & Palleschi, M. (2016). Reducing pressure injury incidence using a turn team assignment. Journal of Wound, Ostomy, and Continence Nursing, 43(5), 477-482. Web. Hultin, L., Karlsson, A.-C., Öhrvall, M., & Gunningberg, L. (2019). Information and communication technology can increase patient participation in pressure injury prevention: A qualitative study in older orthopedic patients. Journal of Wound, Ostomy, and Continence Nursing, 46(5), 383-389. Web. Joseph, J., McLaughlin, D., Darian, V., Hayes, L., & Siddiqui, A. (2019). Alternating pressure overlay for prevention of intraoperative pressure injury. Journal of Wound, Ostomy, and Continence Nursing, 46(1), 13-17. Web. Latimer, S., Gillespie, B. M., & Chaboyer, W. (2017). Predictors of pressure injury prevention strategies in at-risk medical patients: An Australian multi-center study. Collegian, 24(2), 155-163. Latimer, S., Chaboyer, W., Thalib, L., McInnes, E., Bucknall, T., & Gillespie, B. M. (2019). Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. Journal of Clinical Nursing, 28(21-22), 4119-4127. Web. Lin, F., Wu, Z., Song, B., Coyer, F., & Chaboyer, W. (2020). The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. International Journal of Nursing Studies, 102. Web. Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2019). Value of hospital resources for effective pressure injury prevention: A cost-effectiveness analysis. BMJ Quality & Safety, 28(2), 132-141. Razmus, I., & Bergquist-Beringer, S. (2017). Pressure injury prevalence and the rate of hospital-acquired pressure injury among pediatric patients in acute care. Journal of Wound, Ostomy, and Continence Nursing, 44(2), 110-117. Web. Schutt, S. C., Tarver, C., & Pezzani, M. (2018). Pilot study: Assessing the effect of continual position monitoring technology on compliance with patient turning protocols. Nursing Open, 5(1), 21-28. Wang, H.-R. N., Campbell, J., Doubrovsky, A., Singh, V., Collins, J., & Coyer, J. (2020). Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study. International Wound Journal. Web. 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), 207-213. Web.

Appendix B

Variables/Groups, Phenomena, and Data Analysis

Quantitative Studies.

Clinical Questions: State the clinical questions	List of Variables/Groups to Collect Data For: Independent and Dependent Variable(s)	Level of Measurement of Variable Ratio Interval Ordinal Nominal	Instrument(s) or Sources of Data To collect data for each variable	Analysis Plan Data analysis approach to (1) describe data and (2) variables
1 To what degree does the implementation of turning and repositioning patients every two hours impacts the HAPU prevalence rate when compared to doing so once in four hours among hospitalized patients with a Braden Scale of less than 15 in medical inpatient units in hoIsland Hospital over six months?	Independent Variable: Turning and repositioning frequency Dependent Variable: The HAPU incidence rate.	Turning and repositioning: Nominal Incidence rate: Nominal	The E-scale Electronic data retrieval	The Chi-square test of independence.