Date of Doctor of Nursing Practice Project Completion

Spring 5-30-2027

Faculty Advisor

Dr Linda Roussel

Abstract

Abstract

Purpose: This Doctor of Nursing Practice project was created to improve the prevention of pressure injuries in hospice patients receiving care through a Home-based Hospice and Palliative program. The project focused on introducing a standard set of care steps (a care bundle), enhancing caregiver education, and tailoring interventions to meet each patient’s unique needs, with the goal of improving overall patient outcomes.

Background: Pressure injuries remain a common and serious problem in hospice care, especially among patients who are immobile or confined to bed. Although effective prevention methods are known, inconsistent use of these methods, limited caregiver training, and poor documentation have continued to prevent success in many hospice settings. These wounds cause pain, increase infection risk, and reduce quality of life, making prevention especially important in end-of-life care.

Methodology: The project used an evidence-based, phased approach to introduce the Pressure Injury Prevention Care Bundle. This included planned training sessions for staff, creating uniform documentation practices, and establishing procedures to record when patients refused care. The project was guided by recognized frameworks such as the Consolidated Framework for Implementation Research (CFIR), the Iowa Model of Evidence-Based Practice, and the Plan-Do- Study-Act (PDSA) cycle. Data were collected through audits measuring compliance and documentation quality, as well as through caregiver feedback to understand challenges and successes.

Results: After implementation, caregiver adherence to prevention protocols increased from 60% to 85%. Documentation practices became more consistent and thorough. Personalized care planning encouraged greater patient participation. The introduction of formal protocols for recording care refusals ensured that care decisions respected patient wishes, which in turn increased caregiver confidence and patient satisfaction.

Implications: This project demonstrates that combining structured training, evidence-based care steps, and attention to individual patient needs can successfully reduce pressure injuries in home hospice environments. Maintaining these gains requires continued leadership support and regular monitoring. The strategies used in this project may be adapted to other care settings to improve patient safety and quality of life.

Keywords

Pressure injury, care bundle, Home based Hospice

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Nursing Commons

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