Effects of Implementing Pressure Injury Prevention Practice Guidelines in Preterm Neonates Using Non-invasive Ventilation

Abstract

Introduction Non-invasive ventilation (NIV) is a standard treatment for respiratory support for preterm neonates, and its use has been increasing. However, it has been found that the use of NIV carries a high risk of nasal injury in preterm neonates, leading to pain, discomfort, nasal deformities, and prolonged hospital stays. Therefore, the development of nursing practice guidelines to prevent pressure injury from NIV in preterm neonates is crucial in preventing these injuries. 

Objectives 1) To develop a nursing practice guideline for preventing pressure ulcers from noninvasive ventilation in preterm neonates and 2) To test the effects of implementing the guidelines on the incidence of pressure injuries, knowledge and skills of nurses in pressure injury prevention, adherence to the practice guideline, and satisfaction with the use of the practice guideline. 

Research Design This study was a research and development. 

Methodology This study was conducted in four phases: 1) Situation analysis, 2) Guideline development, 3) Guideline implementation, and 4) Outcome evaluation and improvement. The participants comprised 55 nurses working in neonatal intensive care units, sick newborn units, and preterm newborn units, and 308 preterm neonates receiving NIV. The neonates were divided into a control group (using existing guidelines) and an experimental group (using newly developed guidelines), with 154 participants in each group. The research instruments included: 1) A teaching plan on ‘Nursing to Prevent Pressure Ulcers from Non-Invasive Ventilation in Preterm Neonates’, 2) Nursing practice guidelines for preventing pressure injury from NIV in preterm neonates, developed based on empirical evidence, including six key issues: 1) Skin and pressure injury assessment, 2) Preparation of equipment and neonates, 3) Application of nasal continuous positive airway pressure (NCPAP), 4) Post-NIV placement monitoring and care, 5) Early weaning from NIV, and 6) Outcome evaluation. These practice guidelines were reviewed by registered nurses representing the users who implement the guidelines for feasibility, appropriateness, meaning, and effectiveness. The instruments for data collection included four sets: 1) A knowledge and skills assessment form for nurses on preventing pressure injury from NIV in preterm neonates, 2) A compliance assessment checklist for nurses following the practice guidelines, 3) A satisfaction assessment questionnaire for nurses on the practices, and 4) A skin and pressure injury assessment record form for neonates receiving NIV. Data were analyzed using descriptive statistics, Paired t-test, and Chi-square test. 

Results The participants included 55 nurses and 308 preterm neonates, divided into a control group (n = 154) and an experimental group (n = 154). The incidence of pressure injury from NIV in the experimental group (1.9%) was significantly lower than the control group (6.5%) (χ2 = 3.935, p = .04). 3) The knowledge of nurses on preventing pressure injury from NIV in preterm neonates was significantly higher after the training (M = 13.93, SD = 1.74) compared to before the training (M = 10.04, SD = 2.76) (t = -10.380, p < .01). 4) The skills in pressure injury assessment of nurses were significantly higher after the training (M = 8.35, SD = 1.64) compared to before the training (M = 4.40, SD = 2.39) (t = -12.080, p < .01). 5). Nurses’ adherence to the nursing practice guidelines was at the highest level, with a mean score of 28.95 (SD = 2.22), representing 96.5% adherence, and 6) Nurses’ satisfaction with the practice guidelines was at the highest level (M = 4.66, SD = 0.42, Min-Max = 3.4-5.0). 

Recommendation The developed practice guidelines are effective in preventing pressure injuries from NIV in preterm neonates. Nurses working in neonatal units that provide NIV can implement these guidelines to prevent pressure injuries by adapting them to the specific context of their units. Besides, preparing nurses with the necessary knowledge and skills to use the practice guidelines, monitoring adherence to the guidelines, and continuously measuring outcomes for ongoing improvement are keys to success.