Digital Repository Masters Projects Spring 2023 Reducing Hospital-Acquired Pressure Injuries in Oncology Patients Through Nurse Education Samantha Tietjen Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Tietjen, S. 2023. Reducing hospital-acquired pressure injuries in oncology patients through nurse education. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Reducing Hospital-Acquired Pressure Injuries in Oncology Patients Through Nurse Education Project Title by Samantha Tietjen Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 04/11/2023 Date Samantha Tietjen BSN, RN, MSN Student 04/11/2023 Student Name, Credentials Date (electronic signature) Jamie Wankier MSN, RN 04/11/2023 MSN Project Faculty Date (electronic signature) 05/25/2023 Melissa NeVille Norton (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. Date 1 Reducing Hospital-Acquired Pressure Injuries in Oncology Patients Through Nurse Education Samantha Tietjen, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract Hospital-acquired pressure injuries are a significant complication to hospital inpatient oncology care. Due to risk factors, treatments, and chronic conditions, oncology patients in the Medical/Oncology setting present an increased risk for pressure injuries. Nurses are vital in providing pressure injury interventions; however, many nurses do not feel prepared to provide pressure injury interventions for this at-risk population. This MSN project aims to provide nurses with an accessible, comprehensive resource to promote hospital-acquired pressure injury prevention in the Medical/Oncology setting. This project will include an educational E-learning module with adjunct materials to help nurses identify risk factors, interventions, management, and the importance of maintaining skin integrity in oncology patients. The project education will benefit nurses and patients by fostering confidence and providing comprehensive resources to prevent hospital-acquired pressure injuries in oncology patients, reducing associated complications and costs. Recommendations on the implementation and growth of this project are evaluated, and evidence-based research about nurses’ perceived preparedness to mitigate hospital-acquired pressure injuries in oncology patients assists in endorsing the importance of this project for future research and use. Keywords: Hospital-acquired pressure injury, oncology patient, nurse education, patientspecific factors, skin care management 3 Reducing Hospital-Acquired Pressure Injuries in Oncology Patients Through Nurse Education Preventing hospital-acquired pressure injuries is a vital responsibility of healthcare providers (Park et al., 2020). However, there are often barriers to avoiding pressure injuries in a hospital setting. When hospital-acquired pressure injuries are not prevented, they can cause extended hospitalization, recovery, infection, pain, and decreased patient satisfaction (Amon, 2019). Hospital-acquired pressure injuries can ultimately lead to additional costs for patients and organizations due to the potential for an increased length of stay and interventions (Amon, 2019; Holbrook et al., 2021). Pressure injuries can create increased complications for oncology patients, that can be more vulnerable to skin integrity concerns (Lima et al., 2021). Various factors complicate an oncology patient’s predisposition for skin breakdown and pressure injuries. Immunocompromising medications can cause a reduction in the inflammatory and immune response, negatively affecting the healing process (Lima et al., 2021). Radiotherapy and chemotherapy are standard treatments in oncology patients that can lead to integumentary problems that complicate wound healing (Lima et al., 2021). Lima et al. (2021) found that oncology patients have the highest frequency of all classifications of wounds; pressure injuries comprise 60% of the total wounds. Therefore, oncology patients may present a higher risk of altered skin integrity due to treatment, patient-specific factors, and chronic disease (Hogle, n.d.; Lima et al., 2021). Nurses are essential in reducing and preventing hospital-acquired pressure injuries in oncology patients by providing essential interventions for their at-risk patients in prevention and reduction (Lima et al., 2021; Padula & Black, 2019). These interventions include frequent repositioning, seating changes, nutrition, and off-loading devices (Holbrook et al., 2021; Padula 4 & Black, 2019). Preparing nurses through education and standardized prevention protocols can be a powerful tool in preventing and reducing hospital-acquired pressure injuries (Padula & Black, 2019; Park et al., 2020; Tan et al., 2020). Many factors contribute to education, which can empower nursing staff to treat pressure ulcers effectively. One crucial factor is the accessibility of education and support related to pressure injuries (Latimer et al., 2021). Research has shown that educated nurses reduce pressure injuries (Park et al., 2020; Tan et al., 2020). A lack of accessible education for nurses and patients can lead to a decreased understanding of pressure injury prevention (Latimer et al., 2021). In contrast, continual accessible education concerning pressure injury prevention creates a culture of prevention and improves nursing confidence and patient outcomes (Padula & Black, 2019; Park et al., 2020). Many nurses lack a comprehensive understanding of pressure injury prevention within some Medical/Oncology settings, and a lack of accessible educational protocols and resources can compound this problem (Aljezawi & Tubaishat, 2018; Rafters et al., 2021). Statement of Problem Although research has illustrated the importance of accessibility in education for nurses (Latimer et al., 2021), a gap exists in pressure injury prevention resources and training in many Medical/Oncology settings (Aljezawi & Tubaishat, 2018). Education related to pressure injury prevention is vital for nurses to feel confident in their skills (Tan et al., 2020). Aljezawi and Tubaishat (2018) state that only 26.9% of at-risk oncology patients were treated with appropriate pressure injury interventions. Furthermore, the need for appropriate pressure injury interventions for at-risk populations illustrates a strong disconnect in education related to pressure injury 5 prevention (Aljezawi & Tubaishat, 2018). Frequent, continual education is essential in reducing hospital-acquired pressure injuries in the oncology population, which can create a culture of prevention, increase nurse confidence, and improve patient outcomes (Padula & Black, 2019; Park et al., 2020). This MSN project aims to explore if nursing education on hospital-acquired pressure injuries can reduce the prevalence in the oncology patient population. The objectives of this project will be accomplished by inspecting current literature to determine the scale of this problem and to determine best practices to develop and implement an educational program for nurses on pressure injury prevention in the Medical/Oncology setting. Ways Project Contributes to Intended Recipients A project of this type and significance has multiple beneficiaries; many recipients, including Medical/Oncology patients, nursing staff, and hospital administration, can benefit. Oncology patients may benefit from improved patient outcomes and enhanced patient experience from this MSN project. Preventing pressure injuries in oncology patients can improve patient outcomes by diminishing the likelihood of infection, improving comfort, and reducing pain, improving quality of life (Lima et al., 2021; Pramod, 2021). As nurses adhere to pressure injury prevention techniques, patients are less likely to acquire a pressure injury, thus enhancing the patient care experience (Holbrook et al., 2021). Medical/Oncology nursing staff will benefit from this MSN project due to the development of pressure injury education and support for this unique patient population. Nurses are other recipients that can benefit from this MSN project by providing knowledge and resources to reduce the prevalence of pressure injuries and incorporating evidence-based procedures and protocols into their workflow (Latimer et al., 2021; Padula & Black, 2019). 6 Providing nurses with comprehensive, accessible education creates an environment of prevention and healing (Tan et al., 2020). Nurses who feel they have adequate resources are more likely to experience higher confidence and pride in their work (Tan et al., 2020). Organizations could benefit from this MSN project in various ways. An organization's average hospital-acquired pressure injury incident cost ranges from $500 to $70,000 (Padula & Delarmente, 2019). Reducing the prevalence of hospital-acquired pressure injuries through an educational program can improve nurse confidence and competence and enhance nursing knowledge, providing more positive patient outcomes and ultimately reducing organizational costs (Padula & Delarmente, 2019; Tan et al., 2020). Rationale for Importance of Project Skin integrity complications occur due to various factors, including treatment, patientspecific factors, and disease burden (Hogle, n.d.). While nurses are diligent and capable caregivers who strive to promote healing, many nurses lack comprehensive knowledge of pressure injury prevention in the Medical/Oncology population (Park et al., 2020; Rafters et al., 2021). Research indicated that accessible, comprehensive education enables nurses to prevent hospital-acquired pressure injuries (Holbrook et al., 2021; Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). Additionally, oncology and immunocompromised patients are more susceptible to skin integrity complications presented by unique barriers and risk factors (Aljezawi & Tubaishat, 2018; Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). The research recommended that nurses caring for oncology patients should be specialized in their education for this population (Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). Oncology patients with pressure injuries can also experience a decreased quality of life and increased mortality (Guo et al., 2022; 7 Pramod, 2021). Guo et al. (2022) studied the survival of 445 hospitalized cancer patients with pressure wounds. Research indicates that the overall survival time is significantly shorter in cancer patients with pressure injuries (Guo et al., 2022). This shorter survival time illustrates the importance of pressure injury prevention in hospitalized cancer patients (Guo et al., 2022). In addition, oncology patients’ skin care management strategies are specialized and unique to the population (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). Therefore, this MSN project will provide nursing education and support specific to oncology patients at risk for altered skin integrity to bridge the pressure injury prevention education gap in the Medical/Oncology setting. Literature Review and Framework A literature review was conducted to investigate evidence regarding hospital-acquired pressure injury prevention in a Medical/Oncology setting. Research and non-research evidence types were examined. Furthermore, evidence-based change frameworks were identified, analyzed, and evaluated to appraise a framework selection for this project. The Iowa Model Revised was selected as the framework for planning an evidence-based change associated with implementing the MSN project (Melnyk & Fineout-Overholt, 2019). Framework The Iowa Model Revised can be used to incorporate the MSN project change by implementing a multiphase process with feedback loops (Melnyk & Fineout-Overholt, 2019). The Iowa Model Revised was first developed as the Iowa Model thirty years ago by Titler and other researchers (Hanrahan et al., 2019). This model is established in the Diffusion of Innovations Theory and the Quality Assurance Model Using Research (Hanrahan et al., 2019). Almost twenty-five years after, the model was revised into what it is today (Hanrahan et al., 8 2019). The Iowa Model Revised focuses on guiding nurses and clinicians in making decisions that will affect outcomes in healthcare (Hanrahan et al., 2019; Melnyk & Fineout-Overholt, 2019). Due to its design surrounding evidence-based change, the Iowa Model Revised is a valuable framework for this MSN project. The Iowa Model revised includes the following steps: identify issues/opportunities, state a question or purpose, form a team, assemble, appraise, and synthesize evidence, design and incorporate a change, identify and sustain the change, and finally, disseminate results (Melnyk & Fineout-Overholt, 2019). Furthermore, the Iowa Model Revised incorporates feedback loops after each step to analyze, evaluate, and modify the previous step in anticipation of the next phase (Melnyk & Fineout-Overholt, 2019). The Iowa Model Revised will serve as a framework for this project, as seen with step one in identifying a problem, developing a question, and utilizing current research to create and implement a practice change (Melnyk & Fineout-Overholt, 2019). This MSN project addresses the identified opportunity of reducing the prevalence of hospital-acquired pressure injuries by bridging the gap in nursing knowledge. Step two of the Iowa Model Revised (Melnyk & FineoutOverholt, 2019) identifies a question or purpose; the PICOT question for this MSN project is: In hospitalized Medical/Oncology patients, does nurse education related to pressure injury prevention decrease hospital-acquired injuries? After a PICOT question is developed, step three of the Iowa Model Revised incorporates retrieving, analyzing, and assembling evidence that pertains to the clinical question (Melnyk & Fineout-Overholt, 2019). Feedback loops are incorporated throughout the model steps to ensure sufficient evidence and determine if the change is necessary. Step three of the Iowa Model Revised pertains to gathering the information and research needed to support and guide the MSN project’s inquiry into pressure injury prevention in a Medical/Oncology setting (Melnyk & Fineout-Overholt, 2019). After analyzing 9 and incorporating the above steps, step four of the model includes designing a practice change (Melnyk & Fineout-Overholt, 2019). The MSN project’s practice change aims to incorporate an education program for Medical/Oncology nurses. A final feedback loop can be used to determine if the project should be implemented (Melnyk & Fineout-Overholt, 2019). This model will help guide the MSN project by outlining the appropriate steps to inquire and develop a question, analyze, appraise, synthesize evidence, and design and evaluate a change in practice (Melnyk & Fineout-Overholt, 2019). Strengths and Limitations The Iowa Model Revised has many strengths and limitations. Several strengths of the Iowa Model Revised framework makes it exemplary for this MSN project (Martin et al., 2017; Melnyk & Fineout-Overholt, 2019). The Iowa Model Framework emphasizes outcomes and allows for the evaluation and ability to make modifications as the process ensues (Melnyk & Fineout-Overholt, 2019). Furthermore, The Iowa Model Revised emphasizes the steps needed to identify, design, trial, and evaluate a change while incorporating feedback loops (Melnyk & Fineout-Overholt, 2019). The Iowa Model Revised use of feedback loops supports nonlinear quality improvement (Melnyk & Fineout-Overholt, 2019). The Iowa Model Revised has been successfully used in pressure injury prevention research (Martin et al., 2017). Martin et al. (2017) utilized the Iowa Model Revised to determine the effectiveness of a pressure ulcer prevention program and self-awareness campaign entitled “Healthy Skin Wins.” (pp. 474). The successful use of the framework in Martin et al. (2017) study shows several strengths similar to this MSN project. In addition to the strengths, the Iowa Model Revised has several limitations, including the patient’s perspective and ambiguity in implementation (Cullen et al., 2022; Melnyk & Fineout- 10 Overholt, 2019). The model does not analyze the patient’s role in implementation to empower and engage patients for the highest success (Cullen et al., 2022). This means that feedback regarding patient satisfaction, engagement, and outcomes could be limited using the Iowa Model Revised. The Iowa Model Revised also lacks specific strategies to disperse the practice change after it has been decided to implement it (Melnyk & Fineout-Overholt, 2019). Lacking clear strategies related to implementation may cause ambiguity for model users regarding how to disperse findings. However, despite these shortcomings, this model successfully provides expertise in creating an evidence-based change (Melnyk & Fineout-Overholt, 2019). Analysis of Literature A rigorous literature review was completed to explore the topic of pressure injury education among oncology patients. Three major themes were identified to support the MSN project PICOT question: In hospitalized Medical/Oncology patients, does nurse education related to pressure injury prevention decrease hospital-acquired injuries? The first theme identified was that oncology patients present specific barriers and risk factors contributing to altered skin integrity (Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). The second theme discovered was that oncology patients’ skin care management strategies are specialized and unique to the population (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). The third theme found in the research highlighted the need for accessible, thorough education that guided nurses in preventing hospital-acquired pressure injuries. (Holbrook et al., 2021; Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). Search Strategies A literature search was conducted to identify current evidence using Weber State University Stewart Library OneSearch, PubMed, MEDLINE, and CINAHL. The search included 11 Boolean combinations of keywords such as pressure injury prevention, hospital-acquired pressure injury, skin integrity, skin breakdown, oncology, cancer, patients with cancer, education, learning, pressure ulcer, decubitus ulcer, bundle, and protocol. Articles outside of 2017 through 2022 were excluded in this literature review to ensure current research. The literature review processes yielded three themes: Oncology patients have unique risk factors, pressure injury interventions, and management, and education prepares nurses to prevent hospital-acquired pressure injuries. Risk Factors in Oncology Patients Research has shown that oncology patients present unique risk factors contributing to altered skin integrity (Aljezawi & Tubaishat, 2018; Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). Cancer patients have various risk factors based on treatment and patient-specific factors (Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). Treatment Treatments for malignancy, such as oral and intravenous immunosuppressive drugs and radiation therapy, can disrupt skin integrity (Hogle, n.d.; Lima et al., 2021). Oral and intravenous immunosuppressive drugs negatively affect healing (Lima et al., 2021). Immunosuppressive drugs cause a decreased immune response and display of infections (Lima et al., 2021). Researchers demonstrated that by altering how the body responds to infection and inflammatory responses, immunotherapies disrupted the healing process and made patients more susceptible to infections with these skin disruptions (Hogle, n.d.; Lima et al., 2021). In addition, intravenous immunosuppressive drugs can be highly caustic to tissue (Lima et al., 2021). Lima et al. (2021) found that extravasation often leads to altered skin integrity. Additionally, research showed that radiation therapy could inhibit the miotic ability of stem cells, preventing cellular reproduction 12 and weakening the integumentary system (Hogle, n.d.). Various oncology patient treatments, including chemotherapy and radiotherapy, contribute to a patient’s skin integrity. (Hogle, n.d.; Lima et al., 2021). Patient-Specific Factors Patient-specific factors also contribute to altered skin integrity, including Braden score, age, nutrition, and immobility (Aljezawi & Tubaishat, 2018; Guo et al., 2022; Lima et al., 2021). Guo et al. (2022) studied oncology patients’ Braden scores and their relation to mortality and pressure injuries. Results showed that a significantly lower Braden score was associated with a lower survival rate in cancer patients with a pressure injury (p<0.0001) (Guo et al., 2022). In the Guo et al. (2022) study, the median survival time for patients with Braden scores less than 14 is 0.4 months [CI]: 0.4-0.6). Guo et al. (2022) demonstrated that a significantly lower Braden score is related to pressure injury instances and higher mortality rates. Age, nutrition, and immobility are risk factors for altered skin integrity in oncology patients (Aljezawi & Tubaishat, 2018; Lima et al., 2021). A literature review of 16 articles by Lima et al. (2021) found that advanced age was the most identified factor in oncology patients with altered skin integrity. Lima et al. (2021) also found that nutritional deficiency and immobility were the two most cited factors of altered skin integrity. Research showed that patients undergoing chemotherapies are at risk for altered nutrition due to the change in the taste of foods and decreased appetite (Lima et al., 2021). Chemotherapy and radiotherapy can also cause electrolyte changes and abnormalities that can directly impact the prevalence of pressure injuries (Lima et al., 2021). Other research showed that immobility is a significant risk factor for altered skin integrity in the oncology patient (Aljezawi & Tubaishat, 2018). According to Aljezawi and Tubaishat (2018), immobility can be related to the progression of the oncology 13 disease process and the use of analgesics to control patient pain. Poor mobility and inactivity can also lead to poor tissue perfusion, causing skin breakdown (Aljezawi & Tubaishat, 2018). Additional patient factors included prolonged pressure on bony prominences contributing to skin breakdown (Lima et al., 2021). Various research showed that treatment and patient-specific factors pose specialized barriers to maintaining skin integrity in oncology patients (Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). Skin Care Management in Oncology Patients Research on skin care management demonstrated the need for specialized interventions for oncology patients (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). Studies found that alternating pressure and complex negative pressure management are beneficial pressure interventions for oncology patients (Isaac, 2020; Willis & Bryant, 2020). Alternating Pressure Alternating pressure helps prevent pressure injuries in immobile oncology patients (Aljezawi & Tubaishat, 2018; Willis & Bryant, 2020). Nursing staff traditionally reposition patients in the oncology or hospital setting (Aljezawi & Tubaishat, 2018). According to Willis and Bryant (2020), utilizing the correct pressure pump or bed equipment was a factor in successful skin care management. Willis and Bryant (2020) studied the effectiveness of alternative pressure pumps in an urban teaching hospital. Each bed in a 30-bed unit was equipped with alternating pressure pumps over two months (Willis & Bryant, 2020). This study showed that using the correct equipment reduced pressure injury prevalence in high-risk populations (Willis & Bryant, 2020). Aljezawi and Tubaishat (2018) found that Proper equipment and nursedriven repositioning were effective prevention methods for pressure injury prevention. Research showed that regular repositioning and pressure redistributing mattresses were critical 14 interventions in pressure injury prevention in the oncology setting (Aljezawi & Tubaishat, 2018). However, Aljezawi and Tubaishat (2018) noted that 73.1% of patients studied did not receive adequate interventions based on their risk, indicating a need for further education on these interventions. Negative Pressure Wound Therapy Alternating pressure pumps and frequent repositioning were cited as appropriate skin integrity-preserving methods in an oncology setting (Aljezawi & Tubaishat, 2018; Willis & Bryant, 2020). In addition, negative pressure wound therapy with instillation and dwell time (NPWTi-D) is also an effective wound healing method in oncology patients with wounds (Isaac, 2020). NPWTi-D cleans wounds and promotes healthy tissue healing (Isaac, 2020). According to Isaac (2020), NPWTi-D is a tool to improve healthy tissue formation and enhance healing. Oncology patients present unique barriers and risk factors to maintaining skin integrity (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). Furthermore, patients in an oncology setting require specialized interventions for pressure injury prevention, skin care management, and wound treatment due to these contributing factors (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). Pressure Injury Prevention Education Multiple studies identified the importance of accessible, comprehensive education for preventing pressure injuries (Holbrook et al., 2021; Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). A qualitative study by Holbrook et al. (2021) studied the effectiveness of education and pressure redistribution on pressure injury incidence in a hospital. The research showed that education and seating interventions increased comfort (p= 0.05), decreased pain (p= 0.03), and indicated more time out of bed (p= 0.02) (Holbrook et al., 2021). Other research showed that 15 pressure injury education received by nursing staff positively affected patient outcomes (Holbrook et al., 2021; Latimer et al., 2021). Holbrook et al. (2021) found significant improvement in patient-reported outcomes, such as improved comfort, decreased pain, and enhanced patient participation was tied to nursing-led encouragement and education. The type of education and its accessibility are critical factors in preventing pressure injuries (Holbrook et al., 2021; Latimer et al., 2021; Tan et al., 2020). Tan et al. (2020) discussed simulations and in-services as an effective pressure injury prevention training method. Nurses in this study expressed the need for hands-on training in their education (Tan et al., 2020). In addition, educational pamphlets, videos, and bulletin boards were valuable for educating patients and nurses (Tan et al., 2020). Other research showed that knowledge, clinical judgment, and visual recognition were crucial factors in pressure injury prevention (Park et al., 2020). Nurses in multiple studies conveyed a desire for more attainable, comprehensive training to promote decreasing hospitalacquired pressure injuries (Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). Education surrounding pressure injuries can unify nursing theory and reality to decrease the incidence of pressure wounds in an acute care setting (Park et al., 2020; Tan et al., 2020). Summary of Literature Review Findings and Application to the Project This literature review conducted for this MSN project identified barriers and risk factors for impaired skin integrity, treatments and interventions, and educational practices in the oncology setting. The literature confirmed that oncology patients present unique risk factors and barriers to maintaining skin integrity (Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). Furthermore, oncology patients require specialized pressure injury interventions and management (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). 16 Finally, thorough, accessible education prepares nurses to prevent hospital-acquired pressure injuries in oncology patients (Holbrook et al., 2021; Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). Several studies suggested that patients in an oncology setting present unique barriers and risks to pressure injury prevention due to treatment factors and patient-specific barriers (Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). Information suggested specialized treatment methods for skin integrity abnormalities in an oncology setting. These methods included alternating pressure, negative wound pressure therapy, and silicone border dressings (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). Additionally, various studies identified the importance of attainable, comprehensive education in pressure injury prevention (Holbrook et al., 2021; Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). Nurses across multiple studies expressed a need for more accessible, comprehensive training to promote hospital-acquired pressure injury reduction (Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). This information has helped support this project’s potential to diminish the incidence of pressure injuries through education. The literature reviewed suggested that specialized risk factors, barriers, and treatments should be accounted for when teaching about pressure injury prevention in an oncology setting. This project will utilize the information gathered to explore if nursing education related to hospital-acquired pressure injuries can diminish the incidence of these injuries in the oncology patient population. Project Methodology This MSN project is designed to prepare nurses to prevent hospital-acquired pressure injuries in the Medical/Oncology inpatient setting by providing an educational module with 17 adjunct support documents for oncology nurses. Five deliverables have been developed for this MSN project’s implementation. The deliverables will consider various formats when making content available to provide resources for diverse learners. The deliverables include (a) an Elearning module with outlined learning outcomes, (b) a pre-and post-test to assess and address knowledge gaps, (c) a printable skin integrity intervention reference booklet for nursing use, (d) a post-completion survey that will be sent to participants three months after the deliverables are disseminated and (e) a pre-and post-implementation chart audit used as a component for measuring the effectiveness of the performance of the project. Description and Development of Project Deliverables Five deliverables were created to aid in the implementation of this project. This section describes each deliverable and the value they bring to the overall MSN project. A Nurses Role in Skin Integrity Management in Oncology Patients: E-Learning Module The first deliverable is an E-learning module (Appendix A). The module aims to educate and prepare nurses to prevent pressure injuries and manage skin integrity in oncology patients. The learning module will include a list of outcomes derived from current research literature. This module will educate nurses on oncology patients’ unique skin integrity risk factors (Aljezawi & Tubaishat, 2018; Guo et al., 2022; Hogle, n.d.; Lima et al., 2021). In addition, this module will provide education on specialized interventions and skin care management (Aljezawi & Tubaishat, 2018; Isaac, 2020; Pramod, 2021; Willis & Bryant, 2020). Finally, the E-learning module will help nurses to understand the importance of mitigating and reducing pressure injuries in the Medical/Oncology setting (Guo et al., 2022; Padula & Delarmente, 2019; Pramod, 2021). The E-learning module will provide nurses with an accessible, comprehensive resource to 18 understand outcomes related to oncology patients' evidence-based pressure injury prevention interventions. E-Learning Module Pre- and Post-Test The second deliverable created for this project is an E-learning module pre-and post-test (Appendix B). The pre-and post-test will be the same test delivered at the beginning and end of the module and contain information addressed in the module to analyze the nurse’s knowledge of skin integrity issues in oncology patients. Upon completing the post-test, nurses will be given their results categorically so they can see areas of strength and opportunities for growth. Additionally, these tests will be used as a feedback loop to aid in the evaluation of the effectiveness of the project (Melnyk & Fineout-Overholt, 2019). Skin Integrity Management in Oncology Patients: A Reference Booklet The third deliverable developed for this project is a printable reference booklet (Appendix C). This booklet will be available at the end of the module in a downloadable form so caregivers can refer to the information electronically or print it for their convenience. The reference booklet includes current literature for pressure injury prevention in oncology patients, including the outcomes listed in the module. The purpose of this booklet is to provide an added reference to meet a variety of learning styles. Tan et al. (2020) indicated the importance of various training methods to meet many learners’ needs. Post-Completion Survey The fourth deliverable developed for this project is a post-completion survey (Appendix D). The post-completion survey will include nine questions with several question types, including the Likert scale, multiple choice, and free text. This survey will be used to gather 19 feedback from the project’s participants and as a component for evaluating the success of the MSN project. Pre-and Post-Implementation Chart Audit The final deliverable developed for this project is a pre-and post-implementation chart audit (Appendix E). The chart audit will establish a quarterly pressure injury average pre-project implementation and measure pressure injury instances post-implementation. The chart audit will identify many components of patient care, such as the Braden score, turning and repositioning, and nutrition (Aljezawi & Tubaishat, 2018; Lima et al., 2021; Willis & Bryant, 2020). The preand post-chart audit will be the same deliverable used before and after the project to gather data and trend the Medical/Oncology unit’s hospital-acquired pressure injury rate as a tool for measuring the success of this MSN project. Plan and Implementation Process The Iowa Model Revised will be used as a framework for implementing and evaluating this MSN project (Melnyk & Fineout-Overholt, 2019). Implementation of this project will require support from the unit educator, manager, and caregivers in the Medical/Oncology unit. A meeting will be held with a team consisting of the unit manager, educator, and project coordinator to discuss the dissemination of the deliverables (Melnyk & Fineout-Overholt, 2019). The meeting with the unit manager and educator will occur in the unit manager’s office in the Medical/Oncology unit. This meeting will present the importance of the project, the data from the pre-chart audit, and the project deliverables to the unit’s manager and educator to gain support from these stakeholders. Then the dissemination of the deliverables will be discussed. Once permission has been obtained, the project will begin with an email to unit nurses with the project’s contents and a description of the deliverables. The description of the deliverables will 20 include a due date of two weeks from the date the email was sent to allow nurses to complete the deliverables with consideration of the nurse’s schedules and other required tasks. Announcements of the email’s arrival will also be shared in unit huddles to ensure nurses are aware to check their emails to complete the deliverables by the due date. Nurses will complete the deliverables listed above and implement what they have learned into their practice by identifying patients at high risk for altered skin integrity and implementing the appropriate skin care management tools or interventions learned from the deliverables while considering patient-specific diversity, language, and learning styles. Nurses will then educate patient care technicians on collaborative interventions to promote skin care management. These collaborative interdisciplinary processes can encourage high-quality care to mitigate hospitalacquired pressure injuries. Two months after the training, an online post-completion survey will be sent to the unit nurses to gain project feedback and evaluate its effectiveness in decreasing hospital-acquired pressure injuries. The project coordinator will also perform a postimplementation chart audit for data comparison. Based on the survey data and chart audits, modifications will be made to the project’s progression and regularly reevaluated due to the frequent feedback loops of the Iowa Model Revised (Melnyk & Fineout-Overholt, 2019). Interdisciplinary Teamwork Although nurses play an essential role in pressure injury intervention, the reduction and prevention of pressure injuries to improve patient outcomes are best carried out by a collaborative interprofessional team (Lima et al., 2021; Padula & Black, 2019; Suva et al., 2018). This MSN project’s collaborative interprofessional team includes the Medical/Oncology Unit Manager with Hospital Administration, the Medical/Oncology Nurse Educator, Medical/Oncology Registered Nurses, and the Project Coordinator. By participating in 21 interdisciplinary teamwork, the Medical/Oncology team can successfully implement this project’s nurse education plan, improving patient outcomes. Medical/Oncology Unit Manager/Hospital Administration. The manager on this unit is a Registered Nurse (RN) with previous oncology experience. The unit manager must approve this project with buy-in from the hospital administration before the project can be implemented. In collaboration with the hospital administration, the unit manager would establish budget and time allowances for the unit nurses to participate in this education. Finally, the unit manager can assist in this project’s success by encouraging all nurses to complete the online deliverables and appropriately utilize the resources. Medical/Oncology Nurse Educator. The nurse educator is also an RN with previous oncology experience. The nurse educator will be familiar with the deliverables by participating in the project’s contents before the project’s implementation so the nurse educator can act as a resource for questions on the content. The educator can assist in the success of this project by encouraging nurses to complete the deliverables by the due date. The nurse educator can also be a resource for feedback on the deliverables to ensure the structure would be similar to what the unit nurses are used to utilizing and beneficial for the team. Medical/Oncology Registered Nurses. The Medical/Oncology unit’s Registered Nurses (RNs) will be responsible for participating in the education and incorporating the information into their practice as outlined. The RN will complete a pre-and post-test and post-completion survey to assess and address gaps in knowledge and evaluate the project’s implementation. Additionally, the outcomes learned in the online deliverables can be utilized in the patient’s care plan, and other healthcare team members can collaborate to provide skin care management interventions. Unit RNs will be responsible for educating and collaborating with the patient care 22 technician team to provide high-quality, interdisciplinary interventions to improve patient outcomes. Project Coordinator. The project coordinator is a Medical/Oncology skin and wound unit champion RN responsible for researching, developing, planning, and implementing this MSN project. The project coordinator will meet with the unit manager and educator to get permission to implement this project and create and disseminate the deliverables. The project coordinator will gather and present the appropriate data for evaluating this MSN project to make modifications as necessary for its continuation. The project coordinator will also be a resource for questions about the content or deliverable use. Staff ancillary to this team will also assist patients in pressure injury prevention in adjunct measures supportive of this project. The team includes physicians assessing the patient’s holistic needs, care managers coordinating prescribed home resources and promoting postdischarge success, and registered dieticians identifying nutritional deficits and providing nutritional support through various forms of supplementation. Other ancillary members include speech, occupational, and physical therapists, who can support mobility and strength and provide discharge recommendations. Timeline A detailed timeline will help with the seamless implementation of this project. This project’s implementation requires collaborating with the unit manager and educator. First, a short meeting to present and discuss the dissemination of the deliverables and project logistics must occur. The deliverables will be online and ready to utilize during the meeting. The implementation of this MSN project will begin with unit management permission, and the date for the distribution of the deliverables will be determined. 23 On the agreed-upon date, Medical/Oncology unit nurses will receive an email explaining the deliverables and the content. The explanation of the deliverables will include a two-week due date to allow nurses to complete the deliverables. Nurses will complete the pre-test, the Elearning module, and the post-test and receive the reference booklet. The nurse will then apply the learned information to their practice. Two months after completing the training, the nurse will participate in a post-completion survey they receive in their email. The project timeline suggests approximately three months to plan, implement, and evaluate the project (Appendix F). Plan for Evaluation of Project The effectiveness of this project will be determined by comparing the results from the Elearning module pre-and post-test and evaluating the results from the post-completion survey. More correct answers on the post-test than on the pre-test will indicate that nurses successfully increased their knowledge of the outcomes in the E-learning module, indicating a degree of effectiveness. Results from the post-completion survey will also be evaluated to determine this project’s success. An “agree” or higher rating on questions 1-5 will indicate project effectiveness. The survey will also ask nurses to rate the ease of use of the deliverables and the frequency they refer to the reference booklet. A comment section will be used to gather feedback on nursing satisfaction, opportunities for improvement, and additional comments. The project coordinator will identify comment trends and review them with the unit manager and educator to make modifications to the project's effectiveness. Gathering feedback on nurses’ perceptions of the education provided will be critical to evaluating this project. Nurses’ perceptions of the comprehensiveness and accessibility of their education and resources affect patient care (Tan et al., 2020). Providing comprehensive pressure injury prevention education can help nurses incorporate evidence-based interventions and practices into their workflow, unifying theory with 24 reality to decrease the prevalence of hospital-acquired pressure injuries in oncology patients (Latimer et al., 2021; Padula & Black, 2019; Park et al., 2020; Tan et al., 2020). Lastly, a chart audit will be completed before and after this project’s implementation to trend the unit’s hospital-acquired pressure injury rate to measure the effectiveness of the project’s performance. The chart audit will collect hospital-acquired pressure injuries from the last two years to establish a quarterly average. After the project has been implemented, data will be collected to identify trends in the data and compare post-implementation data to preimplementation data. Based on the evaluation of the data, the project coordinator, unit manager, and educator will meet to determine if the project should continue or modifications to enhance the effectiveness of the project to meet or exceed the goal. Project success will be indicated if there is a 5% decrease in hospital-acquired pressure injury prevalence in the first quarter. Ethical Considerations Various ethical considerations must be inspected in this project. Ethical considerations help ensure project accountability, promote participant rights, and avoid error and bias (Resnik, 2020). Inpatient oncology patients at risk for hospital-acquired pressure injuries are vulnerable because they present a higher risk for infection, pain, increased length of stay, higher mortality rate, and decreased comfort (Amon, 2019; Guo et al., 2022). Research indicated that many nurses lack an understanding of pressure injury prevention within Medical/Oncology settings; inadequate comprehensive educational resources may augment this problem (Aljezawi & Tubaishat, 2018; Rafters et al., 2021). Therefore, ethical considerations include patient vulnerability, privacy, personal bias, nurse consent, and privacy. Patient and caregiver diversity should also be considered. When making content available, this project will consider various learning styles, abilities, languages, and cultures. Additionally, patient confidentiality should be 25 considered in this project, and patient information will be kept anonymous and private. Chart audits will be performed to evaluate the project’s effectiveness, and the data gathered will not have patient identifiers attached to ensure privacy. In this MSN project, personal bias could occur due to the role of the project coordinator as an RN at the hospital under study. Throughout this project's research, development, and implementation, it will be imperative to stay impartial to avoid the effects bias could bring to this MSN project. It is essential to be aware of personal preferences, thoughts, and values to avoid incorporating them into this project. Awareness of personal bias will enhance project accountability, trust, confidentiality, and fairness (Resnik, 2020). Participant consent and privacy are other ethical factors to take into consideration. The deliverables will be sent to all nurses on the unit; however, participation will be entirely voluntary. Furthermore, the data collected from pre-and post-tests and post-completion surveys will be anonymous and exclude personal identifiers to ensure privacy. Nurses who participate will be encouraged to answer honestly without fear of retaliation. These considerations will assist in ensuring the ethical implementation of this project. Discussion Hospital-acquired pressure injuries can create complications, leading to poor patient, family, and organizational outcomes (Amon, 2019; Holbrook et al., 2021). Oncology patients are at a higher risk for pressure injuries due to patient-specific factors, treatment, and chronic disease (Hogle, n.d.; Lima et al., 2021). Medical/Oncology nurses are often underprepared to prevent hospital-acquired pressure injuries due to a lack of accessible educational protocols and resources (Aljezawi & Tubaishat, 2018; Rafters et al., 2021). This MSN project aims to reduce hospital-acquired pressure injuries in oncology patients through an educational nursing module 26 with adjunct materials to help nurses identify key risk factors and interventions. This section will discuss the dissemination of the project’s results, nursing significance, strengths, limitations, and additional recommendations. Evidence-based Solutions for Dissemination This project’s results will be disseminated in several ways after its implementation. First, after the data is gathered and analyzed from the first three months of implementation, a report will be compiled from the pre-test, post-test, post-completion survey, and chart audit data. This report will be electronically shared with the hospital’s administrative stakeholders for their evaluation and discussion of the project’s continuation. Second, a staff meeting will be held for the Medical/Oncology unit stakeholders to present the results. These stakeholders will include the unit manager, educator, and registered nurses and will be led by the project coordinator. The project outcomes will be presented via PowerPoint with an open discussion for further evaluation of strengths, limitations, and recommendations for improvement and to identify gaps. Finally, a poster presentation will be developed to share this project with peers and faculty at Weber State University. Significance to Advance Nursing Practice This project can benefit nurses and the oncology patients at risk for hospital-acquired pressure injuries they care for by providing nurses with accessible, comprehensive pressure injury prevention education through several deliverables. Research suggests that nurses are integral in pressure injury prevention (Lima et al., 2021; Padula & Black, 2019). However, a lack of comprehensive understanding and accessible education can lead to poor pressure injury prevention in Medical/Oncology patients (Aljezawi & Tubaishat, 2018; Latimer et al., 2021; Rafters et al., 2021). Additionally, this project benefits patients by potentially reducing hospital- 27 acquired pressure injuries. Oncology patients with pressure injuries are at a higher risk for increased length of stay, mortality, pain, infection, and decreased satisfaction (Amon, 2019; Guo et al., 2022). Providing nurses with comprehensive, accessible education creates higher confidence levels and preventative care, enabling nurses to prevent pressure injuries (Holbrook et al., 2021; Latimer et al., 2021; Park et al., 2020; Tan et al., 2020). Implications Several strengths and limitations have been identified in this project. Strengths include the project’s various educational offerings, tools for future use, evaluation methods, and framework. Tan et al. (2020) suggest that a variety of learning materials is beneficial for comprehensive education for all learners of all types. The project deliverables include a video, booklet, E-learning module, tests, and additional resources to meet the needs of various learning types. Additionally, the deliverables have electronic and printable options as tools that can be used in the future for nurses to refer to. This project uses various evaluation methods to gather quantitative and qualitative data through tests, surveys, and audits to measure the success of this project. Finally, this MSN project incorporates The Iowa Model Revised as a framework for change by implementing a multistep process with feedback loops for frequent assessment, evaluation, and revision, creating an outcome-driven evidence-based change process (Melnyk & Fineout-Overholt, 2019). Several project limitations have also been identified. Limitations include implementation barriers, staff buy-in, and sample size. The improper implementation of the provided education due to staff buy-in may be a limiting factor of this project. To reduce these barriers, participation will be voluntary, and nurses will be educated on the importance of pressure injury prevention, including nursing, patient, and organizational benefits, to foster buy-in. This project will be 28 implemented on a single unit in a large hospital, thus limiting the sample size. However, pending the project’s initial implementation and evaluation, it may become possible to implement this project on similar units across other hospitals within the system. Nurses can experience barriers to recognizing and responding to pressure injuries in oncology patients due to a lack of comprehensive, accessible education (Aljezawi & Tubaishat, 2018; Latimer et al., 2021; Rafters et al., 2021). This project can help reduce obstacles by educating Medical/Oncology nurses to recognize skin integrity risk factors and implement pressure injury prevention techniques. Implementing this project can help decrease the barriers to preventing hospital-acquired pressure injuries. Recommendations While this MSN project utilized many resources to create an effective plan, recommendations are indicated for further improvement and to address any information gaps. The literature review illustrated extensive research regarding risk factors for altered skin integrity in oncology patients, but few studies compare risk factors among different types of cancers (Aljezawi & Tubaishat, 2018; Guo et al., 2022; Lima et al., 2021). Therefore, additional research should be conducted to determine if other risk factors should be explored with different cancer types. This research would be beneficial in improving and expanding this project. If this project were to expand into other oncology units, it would be necessary to determine if the risk factors for pressure injuries were the same among all types of cancers since some oncology units in the hospital system treat specialized cancer types. An additional recommendation for project improvement includes utilizing an interprofessional team. Suva et al. (2018) indicated that using a collaborative interprofessional team could best improve patient outcomes. This project focuses on nursing education; therefore, expanding this education to other healthcare team members, 29 such as patient care technicians, physical therapists, and occupational therapists, could improve patient outcomes. Conclusions Hospital-acquired pressure injuries can cause complications for patients, families, and organizations (Amon, 2019; Holbrook et al., 2021). Nurses are essential in reducing and preventing hospital-acquired pressure injuries in oncology patients by providing vital interventions for their at-risk patients in prevention and reduction (Lima et al., 2021; Padula & Black, 2019). This project aims to provide enhanced pressure injury prevention education for nurses caring for oncology patients by identifying risk factors for skin breakdown and skin care management interventions. As Medical/Oncology nurses implement the findings from the deliverables, caregivers can create a culture of prevention and improved confidence in their practice, which could lead to decreased hospital-acquired pressure injuries in oncology patients. 30 References Aljezawi, M., & Tubaishat, A. (2018). Pressure injuries among hospitalized patients with cancer: Prevalence and use of preventive interventions. Journal of Wound, Ostomy & Continence Nursing, 45(3), 227–232. https://doi.org/10.1097/WON.0000000000000429 Amon, B. V. (2019). Achieving 1,000 days with zero hospital-acquired pressure injuries on a medical-surgical telemetry unit. MEDSURG Nursing, 28(1), 17–21 Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17(1), 1–20. https://doi.org/10.1186/s13012-021-01157-5 Guo, Y., Pattavana, F., Siangco, C., Ngo-Huang, A., Fu, J., Hui, D., & Bruera, E. (2022). Overall survival among patients with cancer and pressure injury and its association with Braden scale score. Journal of Palliative Medicine, 25(8), 1254–1257. https://doi.org./10.1089/jpm.2021.0645 Hanrahan, K., Fowler, C., & McCarthy, A. M. (2019). Iowa Model Revised: Research and evidence-based practice application. Journal of Pediatric Nursing, 48, 121–122. https://doi.org./10.1016/j.pedn.2019.04.023 Hogle, W. (n.d.). Overview of skin issues related to the oncology patient. Oncology Nursing Society. https://www.ons.org/sites/default/files/publication_pdfs/1%20Principles%20of%20Skin %20Care_chapter%201.pdf Holbrook, S., O’Brien-Malone, C., Barton, A., & Harper, K. (2021). A quality improvement initiative to reduce hospital-acquired pressure injuries (HAPI) in an acute inpatient 31 setting by improving patient education and seating. Wound Practice & Research, 29(4), 198–205. https://doi.org/10.33235/wpr.29.4.198-205 Isaac, D. L. (2020). Complex wound management using negative pressure wound therapy with instillation and dwell time in a cancer care setting. Wounds: A Compendium of Clinical Research & Practice, 32(5), 118–122. https://search-ebscohostcom.hal.weber.edu/login/aspx?direct=true&db=cmedm&AN=32804655&site=ehost-live Latimer, S. L., Deakin, J. L., Chaboyer, W. P., & Gillespie, B. M. (2021). Feasibility and acceptability of implementing a patient education pressure injury prevention care bundle in acute care: An interview study. Wound Practice & Research, 29(3), 163–170. https://doi.org./10.33235/wpr.29.3.163-170 Lima, A. R., Ribeiro Palmer, C., & Nogueira, P. C. (2021). Risk factors and preventive interventions for pressure injuries in cancer patients. Revista Estima, 19, 1–13. https://doi.org/10.30886/estima.v19.1005_IN Martin, D., Albensi, L., Haute, S., Froese, M., Montgomery, M., Lam, M., Gierys, K., Lajeunesse, R., Guse, L., & Basova, N. (2017). Healthy skin wins: A glowing pressure ulcer prevention program that can guide evidence-based practice. Worldviews on Evidence-Based Nursing, 14(6), 473–483. https://doi.org./10.1111/wvn.12242 Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Lippincott, Williams, & Wilkins. Padula, W. V., & Black, J. M. (2019). The standardized pressure injury prevention protocol for improving nursing compliance with best practice guidelines. Journal of Clinical Nursing, 28(3/4), 367–371. https://doi.org/10.1111/jocn.14691 32 Padula W.V., & Delarmente B.A. (2019). The national cost of hospital-acquired pressure injuries in the United States. Int Wound Journal,16(3), 634–640. https://doi.org/10.1111/iwj.13071 Park, M., Kim, G., & Kim, K. (2020). The effect of pressure injury training for nurses: A systematic review and meta-analysis. Advances in Skin & Wound Care, 33(3), 1–11. https://doi.org/10.1097/01.ASW.0000653164.21235.27 Pramod, S. (2021). A soft silicone foam dressing that aids healing and comfort in oncology care. British Journal of Nursing, 30(1), 40–46. https://search-ebscohostcom.hal.weber.edu/login.aspx?direct=true&db=ccm&AN=148-85988&site=ehost-live. Rafters, S. L., Schleper, J., Lean, N., Hwang, M., Rohra, A., & Lillington, L. (2021). Geriatric syndrome screening: Implementing an evidence-based process in hospitalized older adults with cancer. Clinical Journal of Oncology Nursing, 25(3), 297–304. https://doi.org/10.1188/21.CJON.297-304 Resnik, D. (2020). What is Ethics in Research & Why is it important? National Institute of Environmental Health Sciences. https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm Suva, G., Sharma, T., Campbell, K. E., Sibbald, R. G., An, D., & Woo, K. (2018). Strategies to support pressure injury best practices by the inter‐professional team: A systematic review. International Wound Journal, 15(4), 580–589. https://doi.org./10.1111/iwj.12901 Tan, J. J. M., Cheng, M. T. M., Hassan, N. B., He, H., & Wang, W. (2020). Nurses’ perception and experiences towards medical device‐related pressure injuries: A qualitative study. Journal of Clinical Nursing, 29(13/14), 2455–2465. https://doi.org./10.1111/jocn.15262 33 Willis, M., & Bryant, D. (2020). Alternating pressure: Is it a critical intervention to prevent pressure injuries in the oncology population?...Scientific and Clinical Abstracts From WOCNext 2020 Reimagined, June 5-7, 2020. Journal of Wound, Ostomy & Continence Nursing, 47, S36. https://search-ebscohostcom.hal.weber.edu/login.aspx?direct=true&db=cin20&AN=145177164&site=ehost=live 34 Appendix A A Nurses Role in Skin Integrity Management in Oncology Patients: E-Learning Module https://express.adobe.com/page/PSy24lCqNJ3eL/ 35 Appendix B Learning Pre-and Post-Test Learning Pre-Test: https://forms.gle/zyx31KfDYVpmrBKW8 36 Learning Post-Test: https://forms.gle/VqteSV4PBFcZnEgg6 37 Appendix C Skin Integrity Management in Oncology Patients: A Reference Booklet https://express.adobe.com/post/la8flSLLO6Lw9/ 38 Appendix D Post-Completion Survey https://forms.gle/ZU4hxiEre6pdZYY29 39 Appendix E Pre-and Post-Implementation Chart Audit Patient Information: Skin Care Management: Encounter #: ______________ Nutrition: Admission Date/Time: ___/___/___ __:__ Dietician Consultation? Y/N Diagnosis: ________________ Nutrition Supplementation? Y/N Treatment: Pressure Redistribution: o Chemotherapy o Oral o IV o Radiation o Immunotherapy o o o o o Nurse-driven turning/repositioning Alternating pressure pump Pressure redistributing mattress Specialty bed (if indicated) Off-loading devices Patient-Specific Factors: Hospital-Acquired Pressure Injury: Age: ____ Date/Time Found: ___/___/___ __:__ Braden Score Data Location: ____________ Braden Score on admission: _____ Medical Device Related? Y/N Braden mobility score upon admission: __________ Braden Score at the time of injury: _____ Braden mobility score at the time of injury: __________ Stage: __________ Date/Time Found: ___/___/___ __:__ Location: ____________ Stage: __________ Medical Device Related? Y/N Wound Care Consult? Y/N 40 Appendix F Timeline Project Implementation Timeline Week 1 Meet with Unit Manager and Educator to review project dissemination and implementation (1 hour). Online deliverables ready to use. Preimplementation chart audit. Week 2 Disseminate deliverables to nurses via email. End of Month 1 E-learning module, preand post-test due. Nurses will implement module outcome into practice immediately following module completion. Months 2-3 Nurses will continue to implement module outcomes into their practice. End of Month 3 Nurses will receive and complete a postcompletion survey. Postimplementation chart audit. Evaluate the project and make necessary changes. Ongoing Evaluate and make improvements to project as needed.