The Effect of Implementing A designed SKIN Care Bundle Protocol on Modifying Nurses' Practices toward Pediatric Intensive Care Unit Patients

Abstract

 Background: Pressure ulcer has been described as one of the most costly and physically debilitating complications in the 20^th century and they are the third most expensive disorder after cancer and cardiovascular diseases.  A significant amount of evidence has accumulated indicating that SKIN care bundle is considered as an essential component of pressure ulcer prevention practice for nurses to combat the incidence of pressure ulcers. However, standardized guidelines and protocols for pressure ulcer prevention in pediatric intensive care units have not been universally implemented. Aim: This study aimed to evaluate the effect of implementing a designed SKIN care bundle protocol on modifying nurses' practices toward pediatric intensive care unit patient.  Subject and method: A quasi experimental design was used. The study was conducted at the pediatric medical intensive care units affiliated to Mansoura University Children's Hospital (MUCH) and international Hospital of Sandoup in El - Mansoura City, Egypt. The study included a convenience sample of 84 nurses, 105 pediatric intensive care unit patients, recruited for six months’ period. Tools: Three tools were used to collect data. Tool 1: An interview questionnaire sheet for nurse's knowledge. Tool 2:  Observational checklist used to determine nurses’ performance regarding SKIN care bundle. Tool 3:   Braden scale risk assessment tool to assess severity of risk for developing pressure ulcer among critically ill pediatric patients. Results: The majority of the studied nurses didn't receive any training program about SKIN care bundle for pressure ulcer prevention and more than one third of the studied nurses had an insufficient knowledge, as well as more than half of the studied nurses had an unsatisfactory practice regarding SKIN care bundle preprogram, which improved to have a sufficient knowledge and a satisfactory practice after the program and at follow up respectively. There was a significant positive association between nurses' knowledge and practice at p < 0.001. Conclusion: The program had a positive effect on the critical care nurses’ knowledge & practices as well as on the pediatric intensive care unit patients as represented by a decrease in percentages of the studied pediatric patients who had a high risk for PUs development to immediately after & at follow up program implementation respectively. Recommendation:  Including SKIN care bundle interventions & Braden risk assessment into nurses’ routine care and developing regular and continuous educational programs for the critical care nurses according to their needs aiming at refreshing their knowledge and improving their practice for critically ill pediatric patients