Repositioning Strategies to Prevent Pressure Injuries in the ICU: Integrative Review on Implementation Factors

Abstract

OBJECTIVE 

To survey the literature to gain insight into nursing facilitators of and barriers to implementation of positioning/turning strategies to prevent hospital-acquired pressure injuries (PIs) in adult critical care patients.

DATA SOURCES 

This integrative review surveyed literature across databases including PubMed, CINAHL, Embase, and Cochrane Library, and through hand searching.

STUDY SELECTION 

Key terms included “pressure ulcer” OR “pressure sore*” OR “pressure injur*” AND “patient positioning” OR “turn” OR “turning” OR “patient repositioning” AND “critical care” OR “intensive care unit*” OR “inpatient*” AND “prevent*.” Peer reviewed, English language articles published within the past 10 years were included. Inclusion and exclusion criteria narrowed the database yield to 432 articles. After title/abstract and full text review, 11 articles were included.

DATA EXTRACTION 

Articles were appraised using the PRISMA flow diagram and the Johns Hopkins Nursing Evidence-Based Practice appraisal tool. Data was extracted and major themes were identified.

DATA SYNTHESIS 

The identified themes were synthesized into factors that facilitated or impeded the nursing implementation of turning/repositioning strategies to prevent hospital-acquired PIs. Facilitators were the use of verbal cues and alerts to improve compliance and nursing education on PI prevention. Barriers to successful implementation were increased nursing workload or burden, lack of staff, and perceived hemodynamic instability in ICU patients.

CONCLUSIONS 

Future interventions can be tailored to mitigate barriers and reinforce facilitators to improve nursing compliance with repositioning/turning strategies. Increased compliance with these measures could aid in PI prevention in adult ICU patients.