Article: Predictors of Patient Participation in Pressure Injury Prevention: An Observational Substudy
Year Published: December 2025
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Some advantages to the proposed recommendation includes 1) it promotes patient empowerment, by encouraging participation it encourages patient autonomy and shared decision making. Making sure patients understand why repositioning and mobility matter are more likely to engage in preventive behaviors 2) there is a potential to reduce pressure injuries, if patients actively reposition, report discomfort early and cooperate with preventive strategies, the occurrences of pressure injuries may decrease 3) Another advantage will be enhancing nurse- patient collaboration, when nurses educate and involve patients, trust and adherence improve. Some disadvantages include 1) not all patients are capable of participating, patients with cognitive impairment, delirium, severe illness or mobility limitations maybe unable to participate. 2) increased nursing time and workload, providing individualized education and ongoing encouragement may increase workload 3) motivation and psychological factors, sometimes pain, depression, anxiety or fatigue may reduce willingness to participate even if education is provided to the patient.
ReplyDeleteDescribe the method used by the author of the study
ReplyDeleteThe study used a quantitative, cross sectional observational sub study design. The researchers collected data at a single point in time from hospitalized patients using structured questionnaires and clinical assessments to measure factors such as knowledge, perceived ability, and level of participation in pressure injury prevention. Statistical analyses, including regression modeling, were used to identify which variable significantly predicted patient participation. Because the study was observational, it identified associations between factors rather than establishing a cause and effect relationship.
2/17/26 Bethany Sobesto
ReplyDeleteDiscuss the research question or main problem discussed in the study?
The goal of the study was to figure out which items would increase patient participation in pressure injury prevention. It was an observational study. The participating patients answered questions in 7 areas. An answer of 1 to 4 was given to each question. 1 was strongly agree, while 4 was strongly disagree. The aim of the study was to gather data about which factors encourage greater patient participation in pressure ulcer prevention. Greater patient participation in pressure ulcer prevention lowers the risk of pressure injury development.
Discuss the sample size used in the study
949 patients were observed in a medical surgical hospital. Of those 949 patients, only 868 patients fit the criteria for the study. Some of the reasons the other patients were excluded included incontinence and an early discharge. The 868 patients used were at high risk for pressure ulcer development. One third of the patients in the study were female and two thirds were male.
1. Describe the method used by the author of the study.
ReplyDeleteThe authors used an observational substudy design that was part of a larger multi-site randomized controlled trial focused on pressure injury prevention. The participants included hospitalized medical and surgical patients who were considered at risk for developing pressure injuries. Within the first 48 hours of recruitment, patients completed a validated 7-item scale called the Patient Participation in Pressure Injury Prevention (PPPIP).
In addition to this scale, the researchers collected information about each patient’s demographics, clinical condition, and other factors related to pressure injury prevention. The data were then analyzed using several statistical methods, including descriptive statistics, correlation analysis, confirmatory factor analysis, and multiple regression. These methods were used to better understand which factors were associated with higher levels of patient participation.
2. Discuss the limitations of the article.
Even though the study included a fairly large sample size of 856 participants, there are still some important limitations to consider. One major limitation is that all participants were already part of a clinical trial. This means the results may not fully represent the general hospital population, since patients in trials are often more closely monitored or may behave differently.
Another limitation is that patient participation was measured using self-reported data. This can introduce bias, because patients might overestimate or underestimate their actual involvement in prevention activities. Self-reports do not always reflect what truly happens in practice.
Lastly, the regression model explained only a very small portion of the variation in participation scores (adjusted R² = 0.017). This suggests that there are likely other important factors influencing patient participation that were not included or measured in the study. Overall, while the study provides useful insights, these limitations should be considered when interpreting the findings.
Describe the sample size of the study
ReplyDelete- Inclusion criteria were adults admitted in previous 36 hours to medical surgical unit of three large metropolitan hospitals whose expected hospital length of stay is more than 24 hours and are at risk for pressure injury. Hospitals used the Waterlow scale as risk assessment tool. Waterlow score of >10 or patients with limited mobility were considered at risk for PI. Patients that were excluded were those that are unable to be turned, had existing sacral PI or lesions on time of recruitment and those that are incontinent on time of recruitment. There were 868 participants who were older adults who had about 2 comorbidities and stayed in hospital for a week. All were at risk to very high risk of PI and about 2/3 were male surgical patients.
Describe the limitations of the article
- Some limitations noted were
1.Findings may not be generalizable to patients not at PI risk, not incontinent due to participants being part of larger clinical trial with strict inclusion and exclusion criteria
2.No available data on patients’ current health status, instead the numbers of comorbidities were used as replacement for health status.
3.Did not measure the patients’ actual PI prevention behavior, patient participation was self reported.
Methods: This study was an observational substudy of hospitalized medical and surgical adults at risk of PI who participated in a larger multi-site PIP randomized controlled trial of a prophylactic sacral dressing. The participants completed the PPPIP scale which is a 7-item scale with response options of 1 (strongly disagree) to 4 (strongly agree) with possible total scores ranging from 7-28, with higher scores representing greater participation. This scale was administered by a research nurse at each study site within 48 hours following study recruitment. Other data included participant demographic and clinical characteristics along with PT-related variables such as Waterlow risk assessment score, if participants received PIP information, and their randomized group allocation.
ReplyDeleteSample: The parent trial inclusion criteria were adults admitted in the previous 36 hours to medical and surgical units of three large metropolitan hospitals, whose expected length of stay was greater than 24 hours who were at high risk for a PT. Patients were defined as either a Waterlow score of greater than or equal to 10 or patient who had limited mobility. Patients were excluded if they were unable to be turned, had an existing sacral PI or other lesion in the sacral area at time of recruitment, had urinary or fecal incontinence, or were unable to speak or understand English if no interpreter was present. In total, 868 of the 954 patients who were randomized in the parent trial completed the PPPIP scale. Eighty-six patients did not complete the scale because they were discharged before data could be collected or declined completion. Twelve patients were removed during the initial analysis, 10 because of missing data that could not be replaced and two because they were outliers, leaving 856 responses for all analyses. About 2/3 of the participants were male.
Sample size. The Sample size of this study was adults admitted to medical and surgical units of three large metropolitan hospitals, whose expected length of stay was going to be over 24 hours and who were also at high risk of pressure injury according to the Waterlow score of greater than or equal to ten. The total number of patients in this study was 856. Although a sample size of 766 would have been enough to have a greater than 95 percent power to detect a small effect.
ReplyDeleteThe limitations in this study included a a few points. First the research participants were part of a larger clinical trial with strict inclusions and exclusions the study might not be able to be generalized to patients not at risk for pressure injury. Next, the study did not have information on the patients health status and had to rely on the comorbidities instead which might not be an accurate measure of generalized health. Third the pressure injury prevention behavior was self reported and not measured directly. Finally the model in this research paper predicted a very small amount of variation in scale scores
ReplyDeleteJanuary article: Predictors of Patient Participation in Pressure Injury Prevention: An Observational Sub study
ReplyDeleteQuestion #1 Discuss the sample size used in the study
The parent trial inclusion criteria were adults admitted in the previous 36h to medical and surgical units of three large metropolitan hospitals, whose expected hospital length of stay was greater than 24h and who were at high risk for a pressure injury. In the state where the study took place, hospitals used the Water low scale as a risk assessment tool. Therefore, patients at risk of pressure injury were defined as either a Water low score of ≥10 or patients who had limited mobility. Patients were excluded if they were unable to be turned, had an existing sacral pressure injury or other lesion in the sacral area at the time they were recruited, had urinary or fecal incontinence , or were unable to speak or understand English if no interpreter was present. When individuals are incontinent, the dressing manufacturer recommends a different process for dressing application, which introduces a difference in the way the dressings are applied within the intervention group. Therefore, the parent trial excluded patients with Incontinence. All participants in the parent trial were included in this analysis. A power analysis showed that with eight predictors, a sample size of 766 would have >95% power to detect a small effect (0.03) with an alpha of p<0.05 [27]. This sample size also allows us to assess the scale's psychometric properties
Question #2 Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
This study has several strengths, including its large, adequately Powered sample, providing confidence in the study's results. They also used an instrument that had previously been shown to be valid and reliable. While most fit statistics were met in their study, and were similar to those previously reported for this scale, two were not. However, given the chi-square is sensitive to large samples, this was not unexpected. Additionally, room mean square error of approximation values of 0.05 to 0.08 are generally considered acceptable, with values 0.0.08–0.1 marginally acceptable, thus some use the criteria of <0.10 [29, 36] which was met in their study. Thus, we conclude the PPPIP scale is valid and reliable.
This research also has some limitations. First, because participants were part of a larger clinical trial with strict inclusion and exclusion criteria, the findings may not be generalizable to patients not at pressure injury risk, not incontinent, or not in a pressure injury study. Second, they did not have data on patients' current health status. They used the number of comorbidities as a proxy for health status, but recognize the two are not the same. Third, we they not measure actual PIP behavior; patient participation was self-reported. Finally, their model predicted a very small amount of variance in scale scores.