Integrative Review: Evidence-Based Nursing Strategies for Preventing Pressure Injuries in Critically Ill Patients in Intensive Care Units

Abstract

Background: Pressure injuries are a critical concern in intensive care units (ICUs), particularly among critically ill patients who are at heightened risk due to prolonged immobility, compromised perfusion, and nutritional deficiencies. Nursing interventions play a pivotal role in preventing these injuries, but their implementation is often hindered by barriers such as staffing shortages and resource limitations. Objective: This integrative review aims to synthesize evidence-based nursing strategies for the prevention of pressure injuries in ICU settings, highlighting effective interventions, challenges, and facilitators to guide clinical practice and policy development. Methods: The review follows the framework proposed by Whittemore and Knafl, including a systematic search of peer-reviewed literature from databases such as PubMed, CINAHL, and Cochrane Library. Studies published between 2013 and 2023 were included, focusing on nursing interventions for pressure injury prevention in ICU patients. A thematic analysis was conducted to identify key strategies and implications. Results: The review identified multiple effective nursing strategies, including the use of validated risk assessment tools, frequent repositioning, advanced support surfaces, skin care protocols, nutritional interventions, and continuous staff education. Barriers such as staffing constraints and limited access to advanced technologies were noted, while facilitators included multidisciplinary collaboration, organizational support, and innovative repositioning systems. Advanced support surfaces and silicone-based products emerged as particularly impactful in reducing pressure injury incidence. Discussion: A multifaceted approach involving risk assessment, preventive skin care, nutritional support, and advanced technologies is essential to minimize pressure injuries in ICU settings. Addressing barriers through enhanced staffing, resource allocation, and ongoing education can improve adherence to evidence-based practices. Conclusion: This review underscores the importance of integrating evidence-based nursing strategies into ICU care to prevent pressure injuries and improve patient outcomes. Future research should focus on overcoming implementation challenges and evaluating the long-term cost-effectiveness of advanced interventions.