Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Jacqueline Fawcett

Second Advisor

Laura L. Hayman

Third Advisor

Jean Connor


Objective: To describe and examine pediatric critical care nurses’ use of a clinical practice guideline for the prevention of pressure injury for infants and children. Background: The Conceptual Model of Nursing and Health Policy guided this study. Pressure injury development is a common hospital-acquired complication that is considered reasonably preventable with the use of evidence-based prevention guidelines. Little is known about pressure injury prevention practices of pediatric critical care nurses caring for children with congenital heart disease.

Research Design: Multicenter, correlational design using survey methodology

Methods: Pediatric critical care staff nurses were recruited from 15 Consortium of Congenital Cardiac Care-Measurement of Nursing Practice pediatric intensive care units from across the United States, who care for pediatric patients with cardiovascular disease. Data were collected using an online survey including the Quick-EBP-VIK instrument to measure the nurses’ knowledge, values, and implementation of evidence-based practice, the EBPQ Scale to measure the nurses’ use of an evidence-based pressure injury prevention clinical practice guideline, the PPIPA Scale to measure the nurses’ perceived barriers to and facilitators of the use of a the prevention clinical practice guideline, and a Background Data Form to collect demographic information.

Results: A total of 311 useable surveys were submitted yielding a 24% response rate. Nurses scored highest on the value domain for evidence-based practice, lower on knowledge, and the lowest on implementation despite nurses’ self-report of high use of the clinical practice guideline recommendations. Nurses self-reported more perceived facilitators of pressure injury prevention care than barriers, although both patient and system-related barriers were identified. The most frequently reported perceived facilitator of prevention care was easy access to alternative pressure redistribution surfaces and positioning aides. The most frequently reported perceived barrier was the unavailability of these surfaces and aides. No relation was found between the value, knowledge, and implementation domains of evidence-based practice and the use of the prevention clinical practice guideline. Conclusion: Study findings can be used as a baseline to inform nursing practice of perceived barriers and facilitators of pressure injury prevention in the care of pediatric intensive care patients with congenital heart disease.


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