Identification of Nursing-Sensitive Indicators on Pressure Injuries/Ulcers: A Systematic Review

Overview

Journal Nurs Inq

Publisher Wiley

Specialty Nursing

Date 2025 Mar 11

PMID 40068124

Authors

Beratiye Oner

Meryem Kilic

Vildan Cakar

Ayise Karadag

Affiliations

Soon will be listed here.

Abstract

This systematic review aims to develop a conceptual framework to identify nursing-sensitive indicators for preventing and managing pressure ulcers. The first step involves defining evidence-based indicators critical to effective prevention and management. The second step examines the relationships influencing the management of these indicators, using insights derived from scientific research findings. This review is guided by a conceptual framework rooted in Structural State Theory and uses a methodological approach. A total of 956 articles were identified through a search of original references from Medline/PubMed, Scopus, Cochrane Library, and CINAHL, covering the period from 2012 to 2023. A systematic review of 29 studies identified 241 relationships between dependent and independent variables. A theoretical conceptual framework highlighted nursing-sensitive indicators (independent variables) related to patients, nurses, pressure injury/ulcer management, organizational structure, and their association with pressure injury/ulcer outcomes (dependent variables). The analysis showed that patient-focused studies had the highest frequency of relationships. This review highlights the complexity of managing pressure injuries/ulcers and the essential role of nursing care practices and interventions in shaping outcomes. The findings highlight the need for specialized wound care nurses and further research on nursing interventions, urging hospitals to invest in structural changes and nurse education.

References

Jiang X, Hou X, Dong N, Deng H, Wang Y, Ling X . Skin temperature and vascular attributes as early warning signs of pressure injury. J Tissue Viability. 2020; 29(4):258-263. DOI: 10.1016/j.jtv.2020.08.001. View

Tew C, Hettrick H, Holden-Mount S, Grigsby R, Rhodovi J, Moore L . Recurring pressure ulcers: identifying the definitions. A National Pressure Ulcer Advisory Panel white paper. Wound Repair Regen. 2014; 22(3):301-4. DOI: 10.1111/wrr.12183. View

Abrahams F, Daniels E, Niikondo H, Amakali K . Students' knowledge, attitude and practices towards pressure ulcer prevention and management. Health SA. 2023; 28:2180. PMC: 9983280. DOI: 10.4102/hsag.v28i0.2180. View

Baernholdt M, Yan G, Hinton I, Cramer E, Dunton N . Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years. Int J Nurs Stud. 2020; 105:103455. PMC: 7279703. DOI: 10.1016/j.ijnurstu.2019.103455. View

Oner B, Zengul F, Oner N, V Ivankova N, Karadag A, Patrician P . Nursing-sensitive indicators for nursing care: A systematic review (1997-2017). Nurs Open. 2021; 8(3):1005-1022. PMC: 8046086. DOI: 10.1002/nop2.654. View

Khalil H, Cullen M, Chambers H, Carroll M, Walker J . Elements affecting wound healing time: An evidence based analysis. Wound Repair Regen. 2015; 23(4):550-6. DOI: 10.1111/wrr.12307. View

Jaul E, Factor H, Karni S, Schiffmiller T, Meiron O . Spasticity and dementia increase the risk of pressure ulcers. Int Wound J. 2019; 16(3):847-851. PMC: 7948688. DOI: 10.1111/iwj.13110. View

Hoedl M, Eglseer D, Lohrmann C . Structure, Process, and Quality Indicators for Pressure Injury Prevention and Care in Austrian Hospitals: A Quality Improvement Project. J Wound Ostomy Continence Nurs. 2019; 46(6):479-484. DOI: 10.1097/WON.0000000000000586. View

Chaboyer W, Thalib L, Harbeck E, Coyer F, Blot S, Bull C . Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis. Crit Care Med. 2018; 46(11):e1074-e1081. DOI: 10.1097/CCM.0000000000003366. View

10.

Santamaria N, Gerdtz M, Sage S, McCann J, Freeman A, Vassiliou T . A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J. 2013; 12(3):302-8. PMC: 7950350. DOI: 10.1111/iwj.12101. View

11.

Lazareth I, Meaume S, Sigal-Grinberg M, Combemale P, Le Guyadec T, Zagnoli A . Efficacy of a silver lipidocolloid dressing on heavily colonised wounds: a republished RCT. J Wound Care. 2012; 21(2):96-102. DOI: 10.12968/jowc.2012.21.2.96. View

12.

Zhang X, Wu Z, Zhao B, Zhang Q, Li Z . Implementing a Pressure Injury Care Bundle in Chinese Intensive Care Units. Risk Manag Healthc Policy. 2021; 14:2435-2442. PMC: 8187104. DOI: 10.2147/RMHP.S292579. View

13.

Sethuraman K, Leekha S, Adediran T, Roghmann M . Association of Pressure injury with body care activities in nursing homes. Wound Repair Regen. 2020; 29(1):53-59. DOI: 10.1111/wrr.12861. View

14.

Probst DClinPrac RN S, Seppanen MNsc RN S, Gerber V, Hopkins MSc RGN DN Cert A, Rimdeika MD PhD R, Gethin PhD PG Dip Wound Care RCN Dip Anatomy Dip Applied Physiology FFNMRCSI G . EWMA Document: Home Care-Wound Care: Overview, Challenges and Perspectives. J Wound Care. 2014; 23 Suppl 5a:S1-S41. DOI: 10.12968/jowc.2014.23.Sup5a.S1. View

15.

Burston S, Chaboyer W, Gillespie B . Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues. J Clin Nurs. 2013; 23(13-14):1785-95. DOI: 10.1111/jocn.12337. View

16.

Soodmand M, Moghadamnia M, Aghaei I, Ghasemzadeh G, Lili E, Homaie Rad E . Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU. Adv Skin Wound Care. 2019; 32(8):359-364. DOI: 10.1097/01.ASW.0000553599.20444.f4. View

17.

Kim C, Bae K . Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study. Int J Nurs Stud. 2018; 80:155-164. DOI: 10.1016/j.ijnurstu.2018.01.001. View

18.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

19.

Li Z, Lin F, Thalib L, Chaboyer W . Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020; 105:103546. DOI: 10.1016/j.ijnurstu.2020.103546. View

20.

Hahnel E, El Genedy M, Tomova-Simitchieva T, Hauss A, Stroux A, Lechner A . The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high-risk intensive care unit patients: a randomized controlled parallel-group trial. Br J Dermatol. 2019; 183(2):256-264. DOI: 10.1111/bjd.18621. View