Abstract

Introduction and Aims: Skin injuries, particularly pressure injuries, pose significant challenges in hospitals, especially for critically ill patients, leading to discomfort and increased healthcare costs. Such injuries profoundly impact patient outcomes, resulting in increased morbidity and mortality rates. Furthermore, these injuries can severely affect patients' quality of life, impeding their recovery. This project at LLUMC aims to address knowledge gaps among ED nursing staff regarding skin injury prevention through targeted education, thereby enhancing nurses' knowledge and confidence in managing these injuries.

Methodology: To evaluate the effectiveness of the skin injury prevention education initiative, eight tools were utilized, including the Gap Analysis Questionnaire, the DNP Practice Inquiry Demographic Questionnaire, and the Nursing Participants Survey. Pre- and post-intervention surveys, utilizing the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0) and the Pressure Ulcer Management Self-Efficacy Scale for Nurses (PUM-SES), were conducted to measure changes in knowledge and self-efficacy among participants. Educational interventions comprised a comprehensive Lesson Plan featuring a PowerPoint presentation and visual posters. The CDC Recommended Training Effectiveness Tool and the CDC Post-Course Questionnaire were implemented to evaluate training effectiveness.

Results: Following the educational intervention, the knowledge survey scores for skin injury prevention indicated that in the pre-education group of 28 participants, the median score was 44.0, with scores ranging from a minimum of 24.0 to a maximum of 64.0. In contrast, the post-education group, comprising 9 participants, demonstrated only minor improvements, with a median score of 48.0 and scores ranging from 32.0 to 64.0. Additionally, there was a notable improvement in self-efficacy regarding skin injury prevention among nursing staff following the intervention. Specifically, their confidence increased in several areas: the ability to assign tasks to assistants rose from 37.0% to 43.8%, planning mobilization programs improved from 14.3% to 31.3%, and making informed decisions in preventing and treating pressure ulcers increased from 25.9% to 43.8%. Furthermore, the number of complete skin assessments conducted in the emergency department also increased, rising from 73.33% (22 out of 30) pre-education to 86.67% (26 out of 30) post-education, while the percentage of partial assessments decreased from 26.67% (8 out of 30) to 13.33% (4 out of 30).

Impact and Significance: This DNP project underscores the importance of evidence-based education in enhancing the knowledge of ED nursing staff regarding skin injury prevention. While initial training improved understanding, minimal changes in knowledge emphasize the need for ongoing education and refresher courses to reinforce skills and improve patient outcomes.

Recommendations: Several recommendations are proposed for ongoing improvement in the department. First, it is essential to implement continuous education strategies to reinforce the knowledge acquired, ultimately leading to improved patient outcomes and a reduction in the incidence of pressure injuries within the hospital setting. The training sessions should cover critical topics, such as proper positioning, skin care routines, and recognizing the early signs of skin damage, to ensure staff remain informed and engaged. Additionally, providing staff with supplementary educational materials, such as brochures or handouts, can further enhance their understanding and awareness of skin injury prevention. Lastly, it is also recommended to continue collecting quarterly data to monitor any declines or improvements in skin injury prevention within the ED.

Keywords: Skin Injury Prevention, Education, Emergency Department, Nurses

LLU Discipline

Nursing

School

School of Nursing

First Advisor

Joanna Yang

Second Advisor

Salem Dehom

Degree Name

Doctor of Nursing Practice (DNP)

Year Degree Awarded

2026

Date (Title Page)

2-3-2026

Language

English

Type

Doctoral Project

Page Count

93 p., 1 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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