Effectiveness of Implementation Clinical Nursing Practice Guidelines for Care of Incontinence Associated Dermatitis in High-Risk Patients in Medical Intensive Care Unit Suratthani Hospital
Keywords:
Clinical Nursing Practice Guidelines, Registered Nurses, Incontinence-Associated DermatitisAbstract
This research and development (R&D) study aimed to investigate the current care situation, develop, and evaluate the effectiveness of Clinical Nursing Practice Guidelines (CNPG) for skin care in patients at risk of Incontinence-Associated Dermatitis (IAD). The study was conducted at the Medical Intensive Care Unit (ICU), Surat Thani Hospital, from February 2025 to March 2026. During the situational analysis phase, the sample consisted of 8 people, including 4 head nurses of intensive care units and 4 leaders of the pressure injury prevention and care team. Data were collected through focus group discussions and analyzed using content analysis. In the development and implementation phase of the clinical nursing guideline, the sample consisted of 50 registered nurses and 160 patients at risk of IAD. The research instruments included the developed CNPG for IAD skin care, a satisfaction questionnaire, and a knowledge assessment tool regarding IAD prevention. Statistical analysis was performed using descriptive statistics and t-tests.
The results of the study indicated that the situational analysis revealed a lack of risk assessment tools and standardized nursing practice guidelines. The newly developed CNPG was categorized into three phases: admission, continuous care, and discharge planning. Evaluation of the guidelines showed that the incidence of IAD significantly decreased from 15.0% to 6.3% after implementation. Following training, registered nurses exhibited a significantly higher level of knowledge regarding IAD prevention and care (p < .05). Furthermore, the nurses reported the highest level of satisfaction with the CNPG (Mean=4.91, SD.= .10). The findings demonstrate that the developed CNPG can effectively enhance the standard of skin care for patients with incontinence, thereby preventing and reducing the occurrence of Incontinence-Associated Dermatitis caused by exposure to stool and urine.
References
Beeckman, D., Van Damme, N., Schoonhoven, L., Van Lancker, A., Kottner, J., Van Beele, H., Gray, M., Woodward, S., Fader, M., Van Bussche, K., Van Hecke, A., Meyer, D., & Verhaeghe, S. (2016). Interventions for preventing and treating incontinence-associated dermatitis in adults. Cochrane Database of Systematic Reviews, 11, CD011627.
Bloom, B. S., Hastings, J. T., & Madaus, G. F. (1981/1986). Handbook on formative and summative evaluation of student learning. McGraw-Hill.
Gray, M., Bliss, D. Z., & McNichol, L. (2022). Moisture-associated skin damage: Expanding and updating practice based on the newest ICD-10-CM codes. Journal of Wound, Ostomy and Continence Nursing, 49(2), 143–151.
Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., & Vedel, I. Mixed Methods Appraisal Tool (MMAT), version 2018. Mixed Methods Appraisal Tool (MMAT), version 2018. Canadian Intellectual Property Office.
Kayser, S. A., Koloms, K., Murray, A., Khawar, W., & Gray, M. (2021). Incontinence and incontinence-associated dermatitis in acute care: A retrospective analysis of total cost of care and patient outcomes from the Premier Healthcare Database. Journal of Wound, Ostomy and Continence Nursing, 48(6), 545–552.
Koetsawat, R., Utthiya, P., & OnThai, C. (2024). Effects of using clinical nursing practice guidelines for the prevention and care of incontinence-associated dermatitis in a private ward, Somdech Phra Debaratana Building, Faculty of Medicine Ramathibodi Hospital. Journal of The Royal Thai Army Nurses, 25(1), 204–211 (in Thai).
Kwangthong, N., Danaidutsadeekul, S., Watanakijkrilert, D., & Angspatt, A. (2023). The effects of skin care protocol on ulcer healing in patients with incontinence-associated dermatitis. Kuakarun Journal of Nursing, 30(1), 14-24.
National Health and Medical Research Council. (1999). A guide to the development, implementation and evaluation of clinical practice guidelines. Commonwealth of Australia.
Notarnicola, I., Lommi, M., Ivziku, D., Carrodano, S., Rocco, G., & Stievano, A. (2024). The nursing theory of complex adaptive systems: A new paradigm for nursing. Healthcare, 12(19), 1997. https://doi.org/10.3390/healthcare12191997
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Lippincott Williams & Wilkins.
Qiang, L., Author, A. A., & Author, B. B. (2020). Investigating ICU nurses’ understanding of incontinence-associated dermatitis: An analysis of influencing factors. WCET Journal, 40(1), 32-38.
Qiao, G., & Banharak, S. (2023). Incontinence-associated dermatitis in older intensive care patients: A review and case report. Journal of Multidisciplinary Healthcare, 16, 3299–3308.
Simim, S., & Banharak, S. (2023). Measuring Translation and Psychometric Testing of the Perineal Assessment Tool (PAT) and Incontinence-Associated Dermatitis Intervention Tool (IADIT) among Patients in Semi Intensive Care Units: A Pilot Study. Science, Technology, and Social Sciences Procedia, 2023(3), NCCR03 (in Thai).
Suwan-on, J., Matchim, Y., & Thongthawee, B. (2024). Nurses' competency in caring for patients with incontinence-associated dermatitis. Nursing Journal CMU, 51(3), 84-95.
Tantiveas, M. (2016). The development of nursing supervisory model for unofficial-time nursing supervisor, Priest's Hospital [Master’s thesis, Burapha University].
Thatsiriniratkul, R., Wattanachai, T., Tonglo, N., & Chatchumni, M. (2024). Prevalence of Incontinence-Associated Dermatitis in Male Semi-Critical Care Unit at Nopparat Rajathanee Hospital. Singburi Hospital Journal, 33(2), 152–161 (in Thai).
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Boromarajonani College of Nursing, Suratthani
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Published articles are copyrighted by the Journal of Boromarajonani College of Nursing, Suratthani.
The content appearing in each article in this academic journal represents the personal opinions of the respective authors and is not affiliated with Boromarajonani College of Nursing, Suratthani, or any other faculty members of the institution. Each author bears full responsibility for all components of their respective article. In the event of any errors, each author shall be solely responsible for their own article.
