Evidence-Based Practice In The Prevention Of Medical Device Related Pressure Injury In Intensive Care Unit

Objective To understand the knowledge,attitude and behavior of ICU nurses on medical device related pressure injury;To appraise and summarize the best evidence for prevention of medical device related pressure injury in adult patients;To explore the method of prevention of medical device related pressure injury based on the best evidence and evaluate its effect in clinical practice in intensive care unit.Methods The first phase:Totally 507 nurses from ICU in 13 tertiary hospitals of Jiangsu Province were investigated with self-designed questionnaire?Status questionnaire on the knowledge,attitude and behavior of ICU nurses in medical device related pressure injury?.The second phase:Clinical question of medical device related pressure injury prevention was raised by using the method of evidence-based nursing.Relevant research retrieval was conducted,and the quality evaluation and evidence level recommendation for various types of studies were carried out.The evidence-based nursing method was used to summarize the prevention evidence of medical device related pressure injury.The situation of the intensive care unit in a third-class hospital in Zhenjiang was evaluated with the combination of the best evidence.Baseline survery was conducted,obstacle factors were analyzed and countermeasures were formulated and implemented.Comparisons including the incidence of medical device related pressure injury,nurses' knowledge and the rate of nurse compliance with the best evidence were performed among the baseline review group,the first round of evidence application group and the second round of evidence application group.Results1.ICU nurses scored(17.51±4.44)?(41.33±4.56)and(19.39±2.86)on knowledge,attitude and behavior of medical device related pressure injury.The score of knowledge was lower.The knowledge score of nurses who had received special training was higher than that of nurses who had not received training(P<0.01).The attitude score was relatively high,and the proportion of "strongly agree" and "relatively agree" of ICU nurses to each item of attitude was more than 90%.The behavioral score was generally acceptable,but the behavioral score of active learning knowledge and attending training and lectures was relatively low,which was only(2.91±0.65)and(2.63±0.73)."too busy work,unclear access to knowledge and lack of lectures and trainings organized by the hospital" were the main influencing factors.2.A total of 5 articles were included,including 1 evidence summary,1 guideline,1 systematic review,2 expert consensus.A total of 5 items of best evidence were summarized with regard to use and placement of medical devices,skin/tissue assessment,skin care,use and selection of preventive dressings and medical personnel education.Finally 22 items of best evidence were summarized.3.The incidence of medical device related pressure injury in the three groups was24.39%,11.62% and 4.26%,respectively.The incidence of medical device related pressure injury in the second round of evidence application group was lower than that in the baseline group,with statistically significant differences(P=0.006).The total score of prevention knowledge related to medical device related pressure injury of ICU nurses in the three groups was(50.00±13.66),(62.90±11.96),and(86.45±8.19),respectively.In this study,a total of 22 pieces of best evidence were screened for clinical application,and the best evidence for the compliance rate of ICU nurses in 3groups was 2,14 and 21,respectively.Conclusion1.ICU nurses have a positive attitude towards the prevention of medical device related pressure injury,but their knowledge and part of behavior are still insufficient.It is necessary to strengthen the special training of ICU nurses on medical device related pressure injuries,improve their knowledge and skills of medical device related pressure injuries,and improve the quality of nursing.2.This study summarized the evidence for the prevention of medical device related pressure injury,providing scientific and effective evidence-based basis for clinical nurses to carry out practice reform.It is suggested to select evidence according to the actual situation of the department for clinical application.3.Clinical practice based on the best evidence can effectively reduce the incidence of medical device related pressure injury in ICU adult patients,improve the knowledge of ICU nurses on the prevention of medical device related pressure injury,narrow the gap between evidence and clinical practice,and improve the quality of nursing.