pressure injury

NIGHTINGALE COLLEGE COURSE OUTLINE

BSN 355: Capstone Proposal

Capstone Project Outcome and Evaluation Template

EXAMPLE

Objective of Project	Outcome of Objectives	Evaluation of Objectives
Write each objective in the column. You should have at least three.	Leave this section blank. This information won’t be available until after you implement your project.	What metric are you going to use to evaluate the objective? (Knowledge quiz, survey etc.)
Decrease the rate of newly developed pressure injuries in high-risk residents by 25% within 12 weeks through the implementation of a two-hour structured repositioning protocol.		Monitor the rate of newly developed pressure injuries in the facility’s reports. Compare baseline data to post-intervention data within 12 weeks. Calculate the percentages to assess if a 25% reduction was achieved.
Enhance nursing staff documentation of repositioning procedures to at least 90% within 12 weeks.		Conduct a weekly audit of documentation of repositioning procedures. Calculate percentages to assess if a 90% rate was achieved.
Enhance staff knowledge and self-efficacy in pressure injury prevention by 20% within 12 weeks.		Conduct pre-education and post-education surveys to assess knowledge and confidence levels. Calculate percentages to assess if a 20% enhancement was achieved.

Identify all expenditures to create, implement, and evaluate your project.

· Budget item: List the item(s) required for your project.

· Description: Describe the item and state what it will be used for.

· Amount needed: State the quantify and dollar value for each item and identify an estimate of the total purchase.

· Proposed Sources: Who will be responsible for purchasing or supplying the item(s) and where the item will be purchased from?

** Do not forget to include travel/mileage, hourly wage for consultant/staff/self.

BSN 355 Budget Requirements

Budget Item	Description	Amount Needed	Proposed Sources
Staff Education Session	In-service training for nursing staff on pressure injury prevention, early skin assessment, as well as the 2 hr repositioning protocol.	1 educator × 2 hrs × $40/hr = $80	Facility staff development educator
Staff Training Time	Nursing staff participation time for attending the session on the repositioning protocol.	5 staff × 1 hr × $35/hr = $175	staffing budget
Educational Materials	Printed handouts and reference guides outlining the repositioning protocol and pressure injury prevention strategies.	30 copies × $1 = $30	Facility printing services
Repositioning Reminder Clocks	Visual bedside turning reminder clocks used to remind staff to reposition high-risk residents every two hours.	10 clocks × $10 = $100	Facility supply department or Amazon
Documentation Tools	Printed repositioning documentation flowsheets or checklist tools used to monitor turning compliance.	Printing cost estimate about $20	Facility electronic health record / nurse manager
Braden Scale Risk Assessment Forms	Pressure injury risk assessment forms used to identify residents at high risk and guide preventive interventions.	50 forms × $0.25 = $12.50	Facility printing services
Penlights for Skin Assessment	Small penlights used by nurses during skin assessments to identify early redness or skin breakdown.	10 penlights × $5 = $50	Medical supply vendor

Chart Audit Time	Time for nurse manager or project leader to conduct weekly chart audits to monitor documentation compliance.	3 hrs × $35/hr = $105	Nurse manager
Data Tracking & Evaluation	project leader to collect and analyze pressure injury data during the 12-week implementation period.	4 hrs × $35/hr = $140	Quality improvement nurse

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For the title page, follow the guidelines below. Information without brackets should remain as written. The learner should replace the information within the brackets with the requested information, and all prior information and brackets should be removed.

Literature Review

Febuary 15, 2026

Prior to submitting your paper, make sure to remove all instructions in brackets on the following pages.

Literature Review

Pressure injuries are a major and preventable patient safety issue in adult healthcare facilities, especially among immobile and high-risk patients. Despite the development of guidelines for prevention, facility-acquired pressure injuries persist because of inconsistent application of evidence-based nursing practices. Repositioning is universally accepted as a basic preventive strategy; however, inconsistencies in frequency, compliance, and measurement have led to inconsistent results. The aim of this literature review is to assess the current evidence on repositioning frequency, compliance with preventive strategies, and system-level factors that affect pressure injury prevention. The question that guides this quality improvement project is: In adult long-term care patients at high risk for pressure injury in a skilled nursing facility, will the application of a scheduled two-hour repositioning strategy, compared to current practice, lead to a 25% reduction in new facility-acquired pressure injuries within 12 weeks? The literature reviewed confirms repositioning as a nurse-initiated strategy and identifies major barriers and facilitators that inform the application of this strategy in a skilled nursing facility.

Project Proposal Topic

To prevent pressure injuries in long-term care facilities, there must be a consistent process of identifying at-risk patients and implementing nurse-driven strategies in a timely manner. While repositioning is a strategy that is encouraged in pressure injury prevention, inconsistencies in implementation and tracking may impact the effectiveness of this strategy in skilled nursing facilities. Variations in adherence to turning schedules, differences in staff workload, and the absence of a standardized tracking system may all impact the ongoing risk of facility-acquired pressure injuries.

The proposed quality improvement project is to implement a two-hour repositioning program for adult long-term care residents who are identified as high risk based on the Braden Scale in a selected skilled nursing facility. The aim of this project is to decrease new facility-acquired pressure injuries by 25% in a 12-week period. This project will help to standardize the frequency of repositioning and track compliance, which will help to improve patient safety outcomes in the selected skilled nursing facility.

Methods of Searching

To obtain relevant literature for this project, the Nightingale College Library was utilized, and the CINAHL Ultimate database was searched. The search terms included “pressure injury,” “pressure ulcer,” “repositioning,” “turning protocol,” “two-hour turning,” and “prevention,” and these terms were combined using Boolean logic to limit the search. Filters were applied to limit the search to peer-reviewed articles published between 2021 and 2026 in English. Articles that specifically targeted pediatric patients, the treatment of existing pressure injuries, or non-research commentary articles were eliminated to keep the literature consistent with the PICOT question targeting prevention.

Systemic reviews, scoping reviews, correlational studies, and intervention studies that targeted repositioning frequency, compliance with prevention strategies, nursing decision-making, and system-level factors influencing implementation were preferred. Five peer-reviewed articles were identified for relevance to the proposed two-hour turning strategy and applicability to skilled nursing facilities or adult care settings.

Review of the Literature

Asiri (2023) performed a systematic review to assess the frequency of turning and repositioning among adult patients to prevent pressure injuries acquired in hospitals. Starting with an initial list of 723 articles, ten articles were selected based on inclusion criteria and assessed using the grading scale of Johns Hopkins Nursing Evidence-Based Practice. The systematic review compared the repositioning times of two, three, four, and six hours. While there was no standard identified, organized and regular repositioning was found to improve pressure distribution and prevent injuries in some studies. This is in line with the implementation of a two-hour repositioning schedule while taking into consideration individual adjustments based on patient conditions.

A review was conducted by Iblasi et al. (2023) to better understand the definition and measurement of repositioning practices in the context of pressure injury prevention research. Twenty-four studies were examined, and it was found that there was considerable variation in the measurement of compliance. Most studies were based on chart review, and no method was found to be completely reliable. This also underscores the need for the inclusion of documentation tools in prevention strategies. In the proposed study, two-hour repositioning will be tracked.

Turmell et al. (2022) assessed the efficacy of wearable sensor technology intended to remind nurses of patient repositioning requirements in a medical intensive care unit. With a pretest-posttest design, patient repositioning compliance increased from 55% to 89%, and average turning times reduced from 3.8 hours to 2.3 hours. These outcomes clearly illustrate the importance of reminder and monitoring tools in improving patient repositioning compliance. Although the study was carried out in a critical care setting, the results indicate that even basic reminder tools could improve patient repositioning compliance in long-term care facilities.

Gassas et al. (2025) conducted a study on the compliance of nurses with pressure ulcer and fall risk assessments using a retrospective record analysis. The results showed inconsistencies in documentation and compliance with standardized assessment tools such as the Braden Scale. Inaccurate and inconsistent risk assessment can lead to delays in the implementation of preventive measures, such as repositioning. The results of the study underscore the need for accurate risk assessment of high-risk patients to ensure timely implementation of preventive measures.

Gwag and Kim (2026) explored the relationship between nursing workload, occupational coping self-efficacy, and preventive behaviors for medical device-related pressure injuries. The results showed that increased workload had a negative effect on compliance with preventive behaviors, but increased coping self-efficacy was positively correlated with compliance. While the study concentrated on device-related pressure injuries, it underscores the system-level factors that influence preventive behaviors. The integration of the two-hour repositioning strategy into the current system may help alleviate workload-related barriers to implementation.

Findings

Repositioning is a fundamental preventive strategy for pressure injuries that has been repeatedly identified in the literature. Systematic and scoping reviews have supported the use of structured turning schedules, although the frequency of turning is still a topic of discussion (Asiri, 2023; Iblasi et al., 2023). Research based on interventions has shown that adherence can be improved by the use of structured cueing systems (Turmell et al., 2022). Moreover, accurate risk assessment and workload are critical for maintaining preventive strategies (Gassas et al., 2025; Gwag & Kim, 2026).

There is a lack of research specifically in long-term care settings that has investigated the use of standardized repositioning strategies in skilled nursing facilities. The majority of the literature has been conducted in a hospital or intensive care unit environment. This lack of research supports the need for facility-based quality improvement projects to investigate the effectiveness of structured two-hour repositioning strategies on high-risk long-term care residents.

Conclusion

The prevention of pressure injuries is an important nursing practice that needs to be done on a consistent basis. Current studies show that repositioning protocols are an effective way to prevent pressure injuries if compliance is maintained. System-level factors play a role in the success of prevention outcomes. The implementation of a two-hour repositioning protocol in a skilled nursing facility has the potential to decrease new facility-acquired pressure injuries by 25% within 12 weeks. This intervention is supported by current evidence as being feasible, measurable, and consistent with quality improvement principles. References

Asiri, S. (2023). Turning and repositioning frequency to prevent hospital-acquired pressure injuries among adult patients: Systematic review. Inquiry, 60, 1–10. https://doi.org/10.1177/00469580231215209

Gassas, R., Alharbi, K., Fallatah, A., & Alamri, A. A. (2025). An evaluation of nurses' compliance with pressure ulcer and fall risk assessments. Nursing Open, 12(12), 1–9. https://doi.org/10.1002/nop2.70376

Gwag, H. S., & Kim, J. A. (2026). Patient safety and quality improvement in nursing practice: Associations among workload, occupational coping self-efficacy and medical device-related pressure injury prevention. Healthcare, 14(2), 270. https://doi.org/10.3390/healthcare14020270

Iblasi, A. S., Aungsuroch, Y., Gunawan, J., & Juanamasta, I. G. (2023). Clarifying repositioning in a pressure injury context: A scoping review. Pacific Rim International Journal of Nursing Research, 27(1), 34–49.

Turmell, M., Cooley, A., Yap, T. L., Alderden, J., Sabol, V. K., Lin, J.-R., & Kennerly, S. M. (2022). Improving pressure injury prevention by using wearable sensors to cue critical care patient repositioning. American Journal of Critical Care, 31(4), 295–305. https://doi.org/10.4037/ajcc2022701