Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2024


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Mercedes Echevarria


Background: Pressure injuries and wound deterioration frequently affect homecare patients. In a palliative care non-profit in Kerala, India who provides home care services, pressure injuries are a problem for their patients despite quality person-centered care.

Objective/Aims: The project objective was to implement the NHS aSSKINg bundle in the organization to prevent pressure injuries. Aim one was to create an organizational policy addressing the aSSKINg bundle. Aim two was to reduce pressure injury prevalence and incidence, with no new pressure injuries development. Aim three was to increase the pressure injury knowledge of 75% of the home care nurses through an increase in Pieper-Zullowski Pressure Ulcer Knowledge Test [PZPUKT] scores. Aim four was to increase caregiver awareness of pressure injury prevention.

Methods: This quality improvement project utilized pre/post testing of pressure injury rates and nursing knowledge. A three-phase policy revision, clinical education, and in-field implementation strategy centered around the NHS aSSKINg bundle was the intervention. Chi square analysis compared the pressure injury rates for statistical significance while two tailed t-testing was utilized to assess for changes in nursing education data.

Results: 13 nurses and 77 patient caregiver dyads participated. A policy was created and presented meeting aim one. Pressure injury prevalence decreased by 12.82% (p= 0.3124), and incidence decreased by 35.89% (p=<0.0001). There was no increase in pressure injuries throughout the study. Regarding nursing education, 87.5% of home care nurses attended the educational session and 100% improved their knowledge as demonstrated by increased PZPUKT scores (p=<0.1). 100% of caregiver participants receiving the awareness intervention were able to teach back the concepts of the aSSKINg bundle.

Conclusions: The aSSKINg bundle is a useful framework to create organization level pressure injury prevention programs. Education of staff and caregivers combined with a support surface supported by policy change can lead to decreases in pressure injuries, even in low resource environments.

Open Access




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