Identification of nursing-sensitive indicators on pressure injuries/ulcers: a systematic review

Abstract

This systematic review aims to develop a conceptual framework to identify nursing-sensitive indicators for preventing and managing pressure ulcers. The first step involves defining evidence-based indicators critical to effective prevention and management. The second step examines the relationships influencing the management of these indicators, using insights derived from scientific research findings. This review is guided by a conceptual framework rooted in Structural State Theory and uses a methodological approach. A total of 956 articles were identified through a search of original references from Medline/PubMed, Scopus, Cochrane Library, and CINAHL, covering the period from 2012 to 2023. A systematic review of 29 studies identified 241 relationships between dependent and independent variables. A theoretical conceptual framework highlighted nursing-sensitive indicators (independent variables) related to patients, nurses, pressure injury/ulcer management, organizational structure, and their association with pressure injury/ulcer outcomes (dependent variables). The analysis showed that patient-focused studies had the highest frequency of relationships. This review highlights the complexity of managing pressure injuries/ulcers and the essential role of nursing care practices and interventions in shaping outcomes. The findings highlight the need for specialized wound care nurses and further research on nursing interventions, urging hospitals to invest in structural changes and nurse education.