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.
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ReplyDeleteDescribe 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.
Discuss the sample size used in the study.
ReplyDeleteThe sample size included a total of 766 participants spanning across three different metropolitan hospitals in a single state. The study had requirements for inpatients requiring greater than a 24 hour hospitalization, Waterlow score greater than 10, and patients who had limited mobility. Exclusion criteria for the sample size included patients who were unable to speak/understand English without the use of an interpreter, individuals who are incontinent or urine or bowel, patient's who were unable to be turned and patient's with an existing sacral pressure injury.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
After the study was completed approximately only two thirds of the sample size reported using the pressure injury prevention tools. There was found to be possible limitations due to patient knowledge- poor explanation, co morbidities/ current health conditions, and patient's current beliefs. It would be better to include a tool that decreases cultural bias and helps obtain better cultural knowledge to healthcare practices before implementing a similar study and program .
Discuss the sample size used in the study
ReplyDeletePatients participation improves patient outcomes but factors that predict participation in pressure injury prevention (PIP)are relatively unknown .This study aimed to identify patient related factors predictive of patent participation in pressure injury prevention (PPPP)in hospitalized in medical and surgical patients and to assess the psychometric properties of the PPPP scale .This observational subsidy recruited conserving adults at risk of pressure who participated in parent trial .The seven item PPPP scale was administered within 48 hours of recruitment with higher scores reflecting more participation .Multiple regression was used to identify patient related factors predictive of patient participation.The scale psychometric properties were assessed using confirmatory factor analysis and cronbachs alpha .In total usable data were obtained from 856 patients .Mean PPPP scale scores were relatively high with 571 (66.7%)scores reflecting agreement or strong agreement .The Cronbachs alpha was 0.81 and most confirmatory factor analysis criteria for construct validity were met .Only these dot mobility aids was statistically significant in the model ,but it predicted a small amount of variability in PPPP score. Targeting patients with limited mobility maybe a useful strategy when trying to engage patients in PIP if resources are limited.
Discuss the limitations of the article:
Studies analyzing predictors of patient participation in pressure injury prevention (PIP)face several methodological limitations ,primarily revolving around reliance on self reported data ,narrow sampling constraints ,and difficulty capturing dynamic clinical factors .Common limitations identified in clinical research include
Reliance on Self Reported Data - Many studies use scale to assess participation rather than directly observing behaviors .Self reported metrics are vulnerable to social desirability bias ,where patients may overestimate their actual engagement in preventive measures.
Narrow Generalizability -Participants in PI studies are frequently drawn from parent trials with strict exclusion criteria (e.g excluding incontinent patients or those with pre existing lesions ).Findings may not represent the broader patient population.
Low Variance Explanation-In predictive modeling (such as multiple regression)identified patient characteristics often account for only a very small amount of the overall variance in participation scores, suggesting that unmeasured environmental or systemic factors play a missive role.
Absence of Clinician Factors -while the focus is on patient predictors ,low participation is often driven by external barriers like nursing time constraints ,staff turnover ,and inadequate patient education delivered by clinicians .
Discuss the sample size
ReplyDeleteThe parent trial inclusion criteria were adults admitted in the
previous 36h to medical and surgical units of three large metropolitan hospitals. Those who expected hospital length of stay was
greater than 24h and who were at high risk for a PI. The sample size included a total of 766 participants spanning across three different metropolitan hospitals in a single state.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Because participants were part of a larger clinical trial with strict inclusion and exclusion criteria, there were many limitations in the study, including that findings may not be generalizable to patients not at PI risk, not incontinent, or not in a PIP study. Second, they did not have data on patients' current health status. Instead the
number of comorbidities were used as a proxy for health status. Third, the actual PIP behavior was not measured and patient participation was self-reported. Finally, the model predicted a very small amount of variance in scale scores.
Discuss the sample size used in the study.
ReplyDeleteThe study included a large sample of 856 hospitalized adult patients who were at risk of developing pressure injuries. These participants were recruited from three large metropolitan hospitals as part of a larger randomized controlled trial, and the sample size exceeded the 766 participants required by the researchers' power analysis to detect small effects with high statistical power. Initially, 868 participants completed the survey, but 12 responses were excluded because of missing data or outliers, resulting in a final sample of 856 patients. The large sample size strengthened the reliability of the findings and allowed the researchers to evaluate the validity and reliability of the Patient Participation in Pressure Injury Prevention (PPPIP) scale.
What are the advantages and disadvantages to the proposed recommendations in the article?
The article recommends increasing patient participation in pressure injury prevention by raising patient awareness, providing education, assessing patient preferences, and using validated tools to better understand patients' knowledge and willingness to participate. An advantage of these recommendations is that greater patient involvement may improve pressure injury prevention, promote patient-centered care, and strengthen partnerships between patients and nurses. The study also suggests that focusing on patients who use mobility aids may be an effective strategy when resources are limited. However, the recommendations also have disadvantages because the study found that mobility aid use explained only a small amount of patient participation, meaning other important factors remain unknown. In addition, not all patients are willing or able to participate in their care, and barriers such as limited health literacy, nurses' workload, and organizational factors may reduce the effectiveness of these recommendations.
by Cindy Wein RN
ReplyDeleteDiscuss the sample sized used in the study.
This research article has a final participation of 856 adult patients that were identified to be at high risk for developing pressure injuries. The data on these patients were from three large hospitals and included patients on medical and surgical units that had a stay for at least 24 hours. The goal of the researchers was to use a large sample size in order to have confidence in the reliability of the study.
Discuss the limitations of the article.
The authors did identify some limitations to their study. One of the limitations identified was that there was no information about the health of the patients that participated in the study. The authors did tally the comorbidities but did not actually analyze their current health status. The authors also identified that the fact that the patient participation was self-reported created a limitation as well. There was no direct observation about the patient participation, therefore the reliance on self-reporting creates limits. Furthermore, the authors identified that the patients in their trial fell into strict criteria and therefore it may not be applicable to a more generalized population of patients.
January 2026
ReplyDeleteDiscuss the sample size used in the study.
The sample size that was used in this study were 868 of the 954 patients completed the PPPIP scale. There were 86 patient who did not complete the scale was because they were either discharged before data collection was completed, or simply decline to participate in the study. Additionally, twelve patients were removed because they were missing data or they were outliers. In the end, there were 856 patients who were analyzed. In order to be included in the study, the patient had to be at high risk for a pressure injury. The study took patients from three different hospitals on medical and surgical units. The large sample size yields fairly reliable results.
Discuss the research question or main problem discussed in the study
The study’s primary issue examined was to identity patient-related factors that predict patient engagement in pressure injury prevention care. The study looked at whether patient characteristics, such as age, gender, number of comorbidities, medical versus surgical and the use of mobility aids impact PPPIP scores. There has been increasing amounts of evidence that shows that the more a patient participates in their care, the better their outcome. The study looked to evaluate if the Patient Participation in Pressure Injury Prevention (PPPIP) Scale is a reliable tool that could be used to measure patient participation.
Describe the method used by the author of the study:
ReplyDeleteThe methods used in this study relate to patient participation in pressure injury prevention and were chosen carefully to understand the factors that contribute to increased patient participation, with the goal of developing strategies that promote engagement in pressure injury prevention care. This study was designed as an observational substudy focused on med-surg adult patients that are at risk of pressure injuries. These patients were all a part of a larger randomized control trial studying prophylactic sacral dressing use across a multi-site population.
Patients included in the study were admitted for greater than 24 hours with a risk assessment score greater than or equal to 10 on the Waterlow risk assessment tool scale. Excluded patient criteria was well defined, with incontinence being the main excluder. A 7-item likert scale response was analyzed for each patient via REDCap. Data was then used to create a multivariable linear regression using a model-builder to identify preictors of scale scores.
Discuss the limitations of the article:
Participants in this substudy were all apart of a larger multi-site clinical trial studying preventative sacral dressings, but that came with very specific inclusion and exclusion criteria. Because patients that were incontinent and unable to be turned were excluded, that makes these results less predictive and not generalizable to patients who do not meet the inclusion criteria. Another limitation is that the substudy did not include additional information about the patient’s current health status, which is a factor that also contributes to the risk of pressure injuries. Examples of this may be malnourishment or comorbidities that slow wound healing. The substudy also did not measure pressure injuries prevention behavior, just self-reported patient participation.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThis study acknowledges that nurses undoubtedly play a key role in pressure injury prevention (PIP). However, it argues that while there is evidence that patient participation can further improve patient care outcomes in PIP, little is known about what actually drives their participation. Researchers primarily sought to identifying patient related variables that could predict patient participation in pressure injury prevention (PPPIP) among high-risk hospitalized medical surgical patients. They examined five patient characteristics, including age, gender, number of comorbidities, medical versus surgical admissions, and the use of mobility aids; and three pressure injury related characteristics including Waterlow risk assessment scores, receiving PIP education, and intervention/ trial group, as possible predictors of PPPIP scores.
What are the advantages and disadvantages to the proposed recommendations in the article?
Given that the only significant statistical predictor of participation revealed in the study was the use of mobility aids, researchers of this study recommend focusing PIP efforts on patients with mobility aid use. They further recommend incorporating targeted discussions with the patient about participation preferences and the use of validated tools such as the Patient Knowledge of and Attitudes and Behavior towards Pressure Ulcer Prevention instrument.
The advantage of targeting patients with mobility aids is that it is a simple, low cost, easily identifiable and applicable criteria that nurse can implement during a busy shift. While the use of the validated tools allows for a more personalized patient care plan for PIP. However, the disadvantage is that the mobility aid predictor in this study only explained a small amount of the variation in those who participated. Therefore, mobility aid use alone would not be a strong predictor of PPPIP and may take away from more impactful strategies.
Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem discussed in this study was to identify patient-related factors predictive of patient participation in pressure injury prevention (PPPIP) in medical and surgical patients. It also aimed to assess psychometric properties of the PPPIP scale. It noted that patient participation improves outcomes yet factors that predict participation in pressure injury prevention are not well known.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
From what the article presents, there are no major disadvantages to implementing this PPPIP scale as it is an easy to administer validated tool to help reduce pressure injuries. It could be done quickly during the nurse’s assessment of their patient’s skin integrity and Braden score, which includes mobility assessment. One advantage to using this PPPIP scale is it raises patients’ awareness of pressure injury risk which educates and empowers patients about their own health. Of note, the authors found that targeting patients with limited mobility can be useful when engaging them in PIP if resources are limited. These patients can be identified easily by using physical therapists’ and bedside nurses’ assessment of patient mobility or by quickly looking at the patients’ Braden score.
Q: Discuss the research question or main problem discussed in the study.
ReplyDeleteA: The focus of this study was to find factors that predict patient participation in pressure injury prevention in med/surg patients. Another focus was to assess psychometric properties of the PPPIP scale. The study found that while nurses play the key role in PIP, patient participation in pressure injury prevention does improve outcomes, but factors that predict that patient participation are not easily identified. The factors they looked at included age, gender, co-morbidities, the use of mobility aids, and if the patients were medical or surgical patients, with the use of mobility aids being the most interesting.
Q: How does this research article compare to our practice, policy and/or procedure?A: On 3N we are hyper aware of PIP and I feel, as a unit, we do a good job of educating patients and families about the dangers of pressure injuries and the value they add in the prevention of these injuries. In my own observations I have noted, over the past 1-2 years, increased pt acceptance of the need to be turned regularly, to wear preventative dressings, etc. Knowledge is power and people generally want to take care of themselves and their loved ones. While there are myriad reasons why patients and families have baulked at allowing Q2 turns, for instance, when clear education is given, participation high. As was the challenge with the study, we are sometimes not able to understand why specific patients and families refuse to participate in their own care, but we are certainly able to see the benefits when they do.
Q.Discuss the sample size in the study.
ReplyDeleteA.This study used a large sample of participants. Participants are adult patients in medical surgical unit who are at risk of developing pressure injury. There is a total of 954 participants initially but only 868 patients were able to complete the PPPIP Scale because 86 patients were discharged before data is collected or declined completion. Twelve patients were removed during initial analysis, 10 because of missing data that could not be replaced and two because they were outliers, leaving 856 responses (98.6% of 868) for all analyses.
Q. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
A. There are few limitations on this study. First, the study has a large number of participant, it maybe to generalized and may not be specific to the criteria such as not a PI risk, not incontinent or not in a PIP study. Second, the comorbidities were used as data instead of current health condition. Third, the actual patient behavior was not measured but is self reported by the participants. And lastly, the model predicted a very small amount of variance in scale scores.
Although, there are some flaws noted. It is no question, that patient knowledge, behavior and perception are important factors to patient participation in pressure injury prevention.
iscuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem discussed in this study is how can we increase patient participation in pressure injury prevention (PIP.) Nurses are mostly responsible for PIP, however there is limited understanding on why patient involvement and participation is low. This study evaluates what patient related factors can determines whether patients want to participate or not.
Discuss the sample size used in the study.
The sample size used in this study included adults that were admitted to medical surgical units from the last 36 hours to three metropolitan hospitals. The adults were to be admitted for more than 24 hours and high risk for pressure injuries. They used the Waterlow risk assessment tool where the patient had a Waterlow score >10 or had limited mobility. Patients that were excluded were those with existing pressure injuries, unable to be turned, or did not understand English if translator was not available.