Setting/Sample:
The study took place in 40 residential aged care facilities located in Australia. A total of 288 aged care residents participated in the study.

Methods:
Residents were randomly assigned to either the intervention group (n=138) or the control group (n=150). In the intervention group, dressings were applied to areas prone to pressure injuries, such as the sacrum and heels, in addition to receiving standard pressure injury prevention care. The control group, on the other hand, received only the standard pressure injury care as recommended by international guidelines.

Data Collection:
Clinical records were utilized for both data collection and analysis, presenting a similar approach that could be adopted in the Direct Practice Improvement (DPI) project.

Data Collection Methods:
– Intervention Group (n=138):
– Dressings applied to susceptible areas (e.g., sacrum and heels)
– Standard pressure injury prevention care

– Control Group (n=150):
– Received standard pressure injury care as per international guidelines

Data Collection Procedures:
Data were collected on a daily basis for both the intervention and control groups. Relevant records pertaining to pressure injury development were examined. These records included:
– Skin assessments on susceptible areas such as the sacrum and heels
– Patients’ mobility status
– Continence status
– Injury risk score

This comprehensive data collection approach aimed to capture key factors influencing pressure injury development, allowing for a thorough analysis of the effectiveness of the intervention in comparison to standard care. The methodology used in this study can serve as a valuable reference for implementing data collection procedures in the DPI project, ensuring a systematic and detailed examination of relevant variables.

King’s theory is rooted in the belief that the care process is transactional, with the nurse playing a central role in assisting patients in maintaining their health (King, 1999). To achieve optimal outcomes, it is imperative that patients comprehend the care process and actively participate in decision-making, essentially becoming care partners in implementing the treatment plan. In the context of the DPI project, the application of King’s goal attainment theory involves a collaborative approach where the nurse and the patient jointly identify the problem, set mutual goals, and devise mechanisms to achieve these goals, aligning with King’s goal theory recommendations (King, 1994). This approach ensures that the goals and functions of both the nurse and the patient are harmoniously aligned.

This collaborative approach will also be mirrored in the implementation of the DPI project’s preventive bundle within the long-term care facility. The nurse will facilitate a mutual understanding, ensuring that patients comprehend the significance of the preventive bundle for pressure ulcers, the targeted outcomes, and their roles in each step of the process. By actively involving patients and aligning goals and functions, the implementation process is more likely to be successful, promoting better patient outcomes in the context of pressure ulcer prevention in the long-term care setting. The DPI project, guided by King’s theory, emphasizes the transactional nature of the nurse-patient relationship, fostering collaboration for improved healthcare outcomes.

Lewin’s theory introduces the concepts of restraining and driving forces, suggesting that these forces influence individuals and groups in varying ways, shaping their reactions to change. Restraining forces seek to maintain the status quo, while driving forces propel change in a direction that triggers its occurrence (Lorenzi & Riley, 2000). Lewin outlines three distinct phases of change: unfreezing, change, and refreezing. The unfreezing phase involves preparing for change, while the change step encompasses the actual implementation of the desired change (Burnes, 2004). Refreezing follows, aiming to solidify the implemented change and make it sustainable over time.

In the context of the DPI project, the unfreezing phase is critical. It necessitates preparation among the organization’s management, patients, and all stakeholders for the changes brought about by the preventive bundle. This preparation involves ensuring a comprehensive understanding of the benefits of the proposed preventive bundle and addressing concerns to minimize resistance. The subsequent change phase involves implementing various components of the preventive pressure bundle, aimed at enhancing patient outcomes by reducing the incidence of pressure ulcers among the elderly and debilitated patients in the long-term care facility.

The final step, refreezing, entails several measures to sustain the change. Continuous evaluation of outcomes, progressive support from management, and the dissemination of results are integral components of this phase. This approach ensures that the change becomes ingrained in the organizational culture, promoting its long-term sustainability. Moreover, sharing the results with other nurses enables the dissemination of knowledge and encourages the implementation of the preventive bundle in the future, fostering a culture of ongoing improvement in patient care practices.