Development of Nursing Practice Guidelines for the Prevention of Pressure ulcers at Thai Hat Subdistrict Health Promoting Hospital, Mueang District, Samut Songkhram Province, Thailand

Abstract

This study employed a research and development (R&D) design to develop, validate, assess feasibility, and pilot test nursing practice guidelines for the prevention of pressure injuries among bedridden patients in a primary healthcare setting. The study was conducted at a sub-district health-promoting hospital in Thailand and consisted of three phases: 1) situation analysis and evidence review, 2) guideline development and quality evaluation, and 3) a pilot implementation study. Participants were ten bedridden patients selected through purposive sampling based on medical records and predefined inclusion criteria. The data were collected from October to December 2025. Standardized instruments were used, including the Braden Scale for pressure injury risk assessment and the Mini Nutritional Assessment (MNA). Quantitative data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation). Changes in pressure injury risk scores before and after guideline implementation were examined using the Wilcoxon matched-pairs signed-rank test. The results demonstrated a statistically significant improvement in overall Braden Scale scores after implementation of the nursing practice guidelines (p < 0.05), particularly in mobility, pressure reduction, and nutritional status domains. No new pressure injuries were observed among participants during the three-month follow-up period. The guidelines were evaluated by healthcare providers as clear, appropriate, comprehensive, and feasible for routine use in the community setting. In conclusion, the developed nursing practice guidelines are evidence-based, practical, and sustainable for preventing pressure injuries among bedridden older adults and patients with chronic conditions in primary healthcare services. The findings support broader implementation of the guidelines, accompanied by staff training and long-term monitoring, to enhance the quality and continuity of community-based nursing care.