title: Pressure Injury Prevention in a Saudi Arabian Intensive Care Unit: Registered Nurse Attitudes Toward Prevention Strategies and Perceived Facilitators and Barriers to Evidence Implementation.
abstract: OBJECTIVE
  The purpose of this study was to examine RNs' attitudes toward pressure injury (PI) prevention strategies. Barriers and facilitators perceived by RNs to potentially impact on the adoption and implementation of PI prevention interventions in the intensive care unit (ICU) were examined.
  
  
  METHODS
  Descriptive cross-sectional survey.
  
  
  METHODS
  The target population was RNs practicing in an intensive care unit (ICU) of a major tertiary hospital, King Abdul-Aziz, Mecca, in Saudi Arabia. Fifty-six of the available 60 ICU RNs participated in this study.
  
  
  METHODS
  Data were collected via survey using the Attitude towards Pressure injury Prevention instrument, which included 13 items rated with 4-point Likert scale, and the modified Barriers and Facilitators tool, which included 27 items. The survey was organized into 3 parts: demographic information, potential barriers to optimal skin care, and potential facilitators to skin care. The survey took 10 to 15 minutes to complete. Data were analyzed with descriptive-correlation statistics and multiple regression analysis. Thematic analysis was undertaken for qualitative data.
  
  
  RESULTS
  Participants demonstrated positive attitudes toward PI prevention (μ = 38.19/52; 73.44%). No significant differences were found between demographic characteristics of the participants with the RNs' Attitude subscale and perceived barriers and facilitators associated with implementing PI prevention in the critical care setting. Several barriers influenced the ability of RNs to implement PI prevention strategies including time demands (β = .388; P = .011), limitation of RNs' knowledge (β = -.632; P = .022), and current documentation format (β = .344; P = .046). Statistically significant facilitating factors that increased respondents ability to undertake PI prevention were ease of obtaining pressure-reduction surfaces (β = -.388; P = .007), collaboration with interdisciplinary teams (β = .37; P = .02), and availability of appropriate skin care products (β = .44; P = .015). Thematic analysis of open-ended questions highlighted workload as a barrier that impedes the implementation of care specific to PI prevention.
  
  
  CONCLUSIONS
  Findings from this study highlighted that ICU RNs had a positive attitude toward PI prevention. This study also identified perceived factors influencing PI prevention in the ICU, both facilitators and barriers. Perceived facilitators included availability of pressure-relieving support surfaces and appropriate skin care products and collaboration with the healthcare professional team. However, perceived barriers included limited PI prevention knowledge of the nurse and RN workflow (time demands and documentation format). Findings from this study provide important information identifying context-specific factors that may influence the adoption and implementation of PI prevention interventions in the ICU.
authors.affiliation: Nahla Tayyib, MN, RN, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia; and Umm Al-Qura University, Faculty of Nursing, Mecca, Saudi Arabia. Fiona Coyer, PhD, RN, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia. Peter Lewis, PhD, MNEd, BN, Cert.CC, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
authors.forename: Nahla
authors.initials: N
authors.lastname: Tayyib
authors.forename: Fiona
authors.initials: F
authors.lastname: Coyer
authors.forename: Peter
authors.initials: P
authors.lastname: Lewis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D009726:Nurses / Q000523:psychology*; D010465:Perception; D003668:Pressure Ulcer / Q000517:prevention & control*; D011594:Psychometrics / Q000295:instrumentation; D012529:Saudi Arabia; D011795:Surveys and Questionnaires