Mentorship program to improve nursing knowledge on prevention of hospital-acquired pressure injuries

Abstract

<p>Problem: In the United States, hospital acquired pressure injuries (HAPIs) is one persistent patient safety problems with an increasing incidence rate resulting in patient harm and patient deaths. Pressure injuries can lead to problems for the patient and family related to wound care and quality of life. Prevention of HAPIs is an essential aspect of nursing practice. Education and mentorship about HAPI prevention can help facilitate translation of evidence-based research findings to clinical nursing practice to improve patient care outcomes. </p> <p>Purpose: The purpose of this DNP project was to evaluate the effectiveness of a mentorship program in improving nursing knowledge on prevention of HAPIs. PICOT Question: For charge nurses (RNs) and preceptor RNs working in the medical-surgical-telemetry unit (MST), what is the effect of a wound ostomy continence nurse (WOCN)-RN mentorship program compared to no prior mentorship program on nurse knowledge of prevention of HAPIs after a two-hour mentoring session? <p>Setting and Sample: The sample consisted of 35 front-line nurse leaders, identified as charge RNs and preceptor RNs, employed in MST nursing units. The study setting was conducted in a 254-bed acute care hospital in Baldwin Park, California. </p> <p>Study Design: The design was a single-site quasi-experimental study design using a nonrandomized pretest/posttest methodology. </p> <p>Methods: The study used the 72-item Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), a standardized and validated instrument with three subcategories (prevention, staging, and wound) for pretest and posttest evaluations. Front-line MST charge RNs and preceptor RNs were invited to participate in a mentoring session with a WOCN mentor. Each study participant (RN mentee) received approximately two hours of WOCN-RN mentoring with a WOCN mentor. The PZ-PUKT pretest was used to assess the baseline pressure injury knowledge of the RN mentee before the prescheduled one-to-one mentoring session with the WOCN mentor. PZ-PUKT pretest score and incorrect test question responses were provided to the WOCN mentor to assess RN mentee’s knowledge gaps. During the mentoring session, the WOCN mentor incorporated patient care activities that addressed knowledge gaps identified by the RN mentee’s PZ-PUKT pretest. The PZ-PUKT posttest was administered after the mentoring session to evaluate the effectiveness of a mentorship intervention to improve nursing knowledge on pressure injury prevention. Each study participant completed a survey to evaluate mentoring program and preferred education modality. </p> <p>Results: The total number of eligible participants was 38, of whom 35 (92%) volunteered to participate in data collection. There was a significant difference in the mean PZ-PUKT pretest scores (M = 70.80, SD = 7.83) and posttest scores (M = 97.57, SD = 1.87) conditions; t(34) = -21.287, p = < 0.001. The average percent delta increase between PZ-PUKT pretest and posttest scores for all participants was 27%. The wound subcategory had the highest percentage of improvement, with an average percent delta increase of 38% after the mentoring session. Pearson’s correlation noted no significant difference between demographic variables and PZ-PUKT pretest and posttest scores. The sample size of 35 limits the generalizability of the results and increases the likelihood of a type II error. By using Cohen's d to estimate sample size, the mean pretest and posttest scores resulted in Cohen’s d = 0.83 (large effect size), with a sample size of 18 with a power of 0.9. A recommendation is for further studies with larger sample sizes, which may demonstrate a significant correlation between demographics and PZ-PUKT pretest and posttest scores. Upon completion of the mentoring session, all of the study participants (N = 35, 100%) indicated that (a) the mentoring session was relevant to their practice, (b) the content improved their knowledge on pressure injury prevention, and (c) they would highly recommend the mentoring program for all current and newly hired nurses. A majority of the participants (n = 29, 83%) preferred the mentoring session over other educational modalities of learning, which included (a) classroom training, (b) online training, (c) online reading, and (d) self-directed learning. The least preferred education modality was reading policies and procedures related to pressure injury prevention (n = 26, 74.3%). </p> <p>Implications: Management of HAPIs is costly. Implementation of evidence-based HAPI prevention strategies can (a) improve patient outcomes, (b) decrease organizational financial burden, and (c) improve care quality. Pressure injuries can be prevented by increasing regular effective training for nurses through mentoring focused on pressure injury prevention interventions and strategies.</p>