NURS 839 Week 7 Assignment 8 Scholarly Project Proposal Example

Scholarly Project Proposal: Protecting the Sacrum and Heels in Operations of Three Hours or More Through a Nurse-Led Silicone Foam Dressing Protocol

Abstract

Background: Pressure injuries that start in the operating room are common after long operations and are often found only later on surgical units. Silicone foam dressings reduce such injuries, but at the project site they are stocked and seldom used. Purpose: To implement and evaluate a nurse-led protocol applying sacral and heel dressings before positioning for adults in operations booked at three hours or longer. Methods: A pre-post quality improvement design will compare twelve weeks after implementation with the same weeks a year earlier in a fourteen-room operating suite, measuring stage 1 or higher sacral and heel injuries within 72 hours and four implementation outcomes. Analysis: Risk differences and relative risks with 95% confidence intervals, chi-square or Fisher's exact tests, a limited logistic model and run charts. Expected contribution: Evidence on whether a proven prevention measure can be delivered reliably in a community operating suite.

Problem and Purpose

Patients under anesthesia lie motionless for hours on firm surfaces and cannot sense the pressure building over their sacrum and heels. Injuries that begin this way often surface a day or two later, when the patient is on a surgical unit and the cause is hard to trace. At the project hospital, wound care nurses recorded 47 sacral or heel injuries within three days of long operations in the past year, and the silicone foam dressings that could prevent many of them sit unused on operating room shelves because no protocol says who should receive them.

The purpose of the project is to make prophylactic dressing a reliable part of care for long operations and to measure whether doing so lowers injury rates. The PICOT question asks whether, for adults booked for supine, prone or lithotomy operations of three or more hours of anesthesia, a protocol under which the circulating nurse covers the sacrum and each heel with multilayer silicone foam ahead of final positioning, kept on up to three days, lowers stage 1 or worse sacral and heel injuries in the first 72 postoperative hours compared with the same weeks of the prior year under usual practice.

Significance and Framework

Each prevented injury spares a patient pain, wound care and possibly a longer stay, spares nurses the uncertainty of injuries no one can trace and spares the hospital a reportable harm. The work will follow the Iowa Model of Evidence-Based Practice, from its trigger, injuries found after long operations, through its decision points about priority, evidence, piloting and integration (Iowa Model Collaborative, 2017). Moran et al. (2017) see a framework as the thread tying together what a project asks, what it knows and how it will find out, and the Iowa Model's pilot decision at month 3 and integration decision at month 12 give the project its milestones.

Evidence

Three findings emerge from the evidence. First, silicone foam prevents pressure injuries: the most recent pooled analysis of randomized trials found the risk of stage 1 sacral injury reduced to less than a fifth of usual care (Fu et al., 2025), and surgical trials showed fewer injuries both during operations (Wang et al., 2026) and on wards afterward (Yeo et al., 2023). The trials' main weakness, unblinded assessment of stage 1 injuries, argues for careful assessment in this project. Second, risk in surgery is not only a matter of time on the table; diabetes, obesity, low albumin and vasoactive infusions were linked to injury in a review of observational studies (Johansson et al., 2026). Third, prevention stalls in operating rooms for organizational reasons, including missing supplies, poor fit with routines and weak communication between departments (Gao et al., 2026). The gap this project fills is practical: no study among those reviewed tested this exact protocol as routine practice in a community operating suite.

Methodology

Design and Setting

The design compares two periods, before and after the protocol, in the manner of a quality improvement project with a historical control. Twelve weeks of eligible cases after launch will be compared with the corresponding twelve calendar weeks of the previous year. The setting is the fourteen-room main operating suite and four surgical units of a 350-bed nonprofit community hospital. Known threats, concurrent changes, differences in how carefully injuries are sought and the small number of expected events, will be recorded and discussed rather than ignored.

Participants

Eligible patients are adults booked for at least three hours of anesthesia, plus adults with diabetes or class III obesity at any booked duration, who stay at least one night after surgery. Patients with existing sacral or heel injury, adhesive allergy or planned admission to intensive care are excluded. About 600 eligible patients are expected in each period.

Intervention

Approved as a nursing standing order, the protocol flags eligible cases on the surgical schedule the day before, has the preoperative nurse document the condition of the sacrum and heels, has the circulating nurse apply the three dressings after induction and before positioning in agreement with the surgeon about sacral placement, records the dressings in the intraoperative record and asks unit nurses to lift and inspect them every shift until they come off at three days or discharge.

Measures

The primary outcome is any new stage 1 or higher sacral or heel injury within 72 hours, staged with the revised national system (Edsberg et al., 2016) and confirmed by two wound care nurses. Skin will be checked with an approach that adds warmth, firmness and pain to visual inspection so that early injury is not missed in darker skin (Neu et al., 2026). Secondary outcomes are injury stage, device-related injury and length of stay. Implementation will be tracked through adoption by surgical service, the share of eligible cases fully dressed, a weekly fidelity audit and a staff acceptability survey (Proctor et al., 2011).

Analysis

Feedback on the methodology and the SPSS rehearsal led to two revisions. Results will lead with the risk difference and relative risk and their 95% confidence intervals, with chi-square or Fisher's exact tests in support, and the logistic model will be limited to two covariates chosen in advance, diabetes and anesthesia time, because few injuries are expected. Patient characteristics will be compared across periods, implementation measures reported descriptively and weekly data displayed on run charts. Results will be broken down by skin tone category.

Protection of Participants

The project lead has completed CITI human subjects training. Quality improvement status will be confirmed by the hospital's review board and the university before data collection. Records will sit on the hospital's protected network, identified only by study number, with the key held separately, and no identifiable information will leave the hospital.

Reporting and Dissemination

Results will be written following SQUIRE 2.0, which asks reports of improvement work to describe context, the intervention as carried out, outcomes and unintended effects (Ogrinc et al., 2016). Operating room staff will see results on the unit dashboard and in huddles, surgeons at their department meeting, hospital leaders through the board's quality committee and the profession through a regional conference poster and a manuscript. If results are disappointing, the implementation data will show whether the protocol failed or was not delivered, and that finding will be reported as fully as a success. A proposal earns trust by planning to report whatever happens, not only what it hopes will happen.

Sustainability, Timeline and Budget

The schedule flag, checklist item and standing order make the protocol part of the system, and once the project closes, monthly audits pass to the wound care nurse. Weeks 1 and 2 prepare staff and systems, weeks 3 through 14 collect data and weeks 15 and 16 complete analysis and reporting. The main costs are about 1,800 dressing sets at roughly $14 each, paid education hours for 60 staff, the informatics work behind the schedule flag and report, and conference costs for dissemination; Roush (2019) recommends naming such practical requirements early so that the project is feasible within the program's timeline.

Limitations

The project's conclusions will be limited in several ways. A pre-post comparison cannot exclude other explanations for any change. The comparison period's injuries were found through consultations rather than structured assessment, so the baseline may be undercounted, which would bias the project toward finding no improvement. With about a dozen expected injuries per period, the estimates will be imprecise. And the project takes place in one hospital, so its findings will apply most directly to similar community operating suites.

Biblical Foundation

Jesus told His disciples that whatever they did for the least of His brothers and sisters, they did for Him (English Standard Version Bible, 2001/2016, Matthew 25:40). A patient asleep on an operating table cannot ask for anything. Protecting that patient's skin is service offered to someone who will never know it was given, which is close to the heart of what Jesus described.

Conclusion

The project addresses a gap between strong evidence and everyday practice in a community operating suite. A nurse-led protocol, a pre-post evaluation that measures both outcomes and implementation and an honest plan for reporting results together give the hospital a way to find out whether prophylactic dressing can become routine and whether, when it does, fewer patients wake with injuries they did not have when they went to sleep.

References

Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing, 43(6), 585-597. https://doi.org/10.1097/WON.0000000000000281

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Fu, T., Wu, X., & Yu, B. (2025). Efficacy of silicone foam dressings in preventing pressure injuries in the sacral and heel areas of patients: A meta-analysis. Frontiers in Medicine, 12, Article 1644290. https://doi.org/10.3389/fmed.2025.1644290

Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Johansson, V. R., Dahl, O., Falk, A. C., Nilsson, U., Dehara, M., & von Vogelsang, A. C. (2026). Risk factors for position-related injuries in adult surgical patients: A systematic review and meta-analysis. International Journal of Nursing Studies Advances, 11, Article 100676. https://doi.org/10.1016/j.ijnsa.2026.100676

Moran, K., Burson, R., & Conrad, D. (Eds.). (2017). The doctor of nursing practice scholarly project: A framework for success (2nd ed.). Jones & Bartlett Learning.

Neu, C., Furtado, S., Dyck, R., Sheikh, F., Tremain, L., & Johnson, D. (2026). Early identification of pressure injury: An equity-informed initiative. Advances in Skin & Wound Care, 39(6), 288-293. https://doi.org/10.1097/ASW.0000000000000475

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Roush, K. (2019). A nurse's step-by-step guide to writing your dissertation or capstone (2nd ed.). Sigma Theta Tau International.

Wang, C. Y., Liao, H. H., Hsieh, M. Y., & Lee, C. H. (2026). Soft silicone foam dressing for preventing intraoperative pressure injuries: A randomized controlled trial. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.08.022

Yeo, H., Hwang, J., Lee, M., No, D., & Jang, I. (2023). Effect of a prophylactic dressing for sacral pressure injuries in non-critically ill patients after general surgery: A randomized controlled trial. Worldviews on Evidence-Based Nursing, 20(3), 259-268. https://doi.org/10.1111/wvn.12651