Document Type

Final Project

Graduation Date

Spring 5-6-2023

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Sue Barnason, Ph.D., RN, APRN-CNS, BC, CEN, CCRN, FAEN, FAHA, FAAN

Second Advisor

Dr. Jennifer Miller, Ph.D., APRN-NP, BC


Purpose and Aims

Medical device related pressure injuries (PI) account for as much as 61-81% of all hospital reported wound incidents (Gefen et al., 2020) and are frequently caused by respiratory devices such as non-invasive ventilation (NIV). Use of NIV in critically ill patients dramatically increased during the pandemic. PI are one of the leading causes of injury to hospitalized patients and lengthens hospital stays (National Pressure Injury Advisory Panel [NPIAP], 2019). The NPIAP recommends routine skin assessment under devices, proper mask fit, protective barrier, moisture reduction, and interdisciplinary collaboration to prevent PIs from NIV masks. This feasibility study’s purpose was to evaluate the use of a nurse-led NIV Pressure Injury Prevention (PIP) algorithm for critically ill patients. Study aims focused on reach (utilization), assessment of effectiveness, adoption, implementation fidelity, and potential maintenance of the NIV PIP algorithm.

Theoretical Framework

The RE-AIM framework was used to guide the delineation of the NIV PIP algorithm implementation plan and evaluation of the algorithm by the critical care nurses.


A prospective study design was used for this feasibility study conducted in a large Midwestern community hospital (640 beds) on two critical care units. Nursing staff participated in an educational session, prior to the implementation of the NIV PIP algorithm on the nursing units. Data was collected over the two-week implementation period. Data collection included pre/post NIV PIP educational survey data, bedside rounding with nurses focused on use of the algorithm, usability of algorithm with the Systems Usability Scale (SUS) pre/post implementation, and medical record review of nurse documentation.


A total of 69 nurses participated in the NIV algorithm educational session. During the study period, 16 NIV patients were hospitalized at study units and no NIV PIs originated on the study units. Nurses completed pre (n=35) and post (n=10) surveys with mean scores increasing from 66.6% (SD 12.82) to 77.8% (SD 20.48). The pre-SUS (n=21) mean was 83.33 (10.73) and the post-SUS (n=4) mean improved to 85.63 (SD 8.26). Bedside rounding revealed that 86% of nurses (n= 20) interviewed reported ease of use of the algorithm and no major disruption to their workflow. Consensus from the nurses was that the NIV PIP algorithm was helpful in their care of NIV patients.


Further study is warranted to evaluate the impact of the NIV PIP algorithm. The increased need for NIV therapy among critical care patients necessitates the need for use of evidence-based practices such as the NIV PIP algorithm The data from this study can serve as a framework to support practice change, interdisciplinary collaboration, and provide awareness of possible clinical barriers.