The effect of care package application in the pediatric intensive care unit on preventing medical device-related pressure injuries

The study was carried out in two stages: adapting the Braden QD Scale to Turkish society and determining the effect of the care package in the pediatric intensive care unit in preventing medical device-related pressure injuries. While the first stage of the study was methodologically carried out, its second stage was conducted as randomized controlled. The study was carried out in the pediatric intensive care units of a maternity and children's hospital and a training and research hospital affiliated to the Ministry of Health.The first stage of the study was carried out with 71 patients hospitalized in the pediatric intensive care and palliative units. In the second stage of the study, a checklist for preventing medical device-related pressure injury with the Delphi method and a care package for endotracheal intubation tube, nasogastric tube, and saturation probe application were prepared. A pilot study was conducted with 10 pediatric patients, and the sample size was calculated as 70 pediatric patients including 35 in the intervention group and 35 in the control group 1 for mean score of the Braden QD-T adapted into Turkish in the first stage, the Cohen d effect size of 0.6, type I error of 5% and at least 80% power. In another unit, 24 children were recruited for the control group 2. Assignment of children in groups was determined by using simple random randomization method. SPSS (Statistical Package for Social Sciences) 25.0, Lisrel 8.80 and MedCalc statistical package programs were used in the study. Content Validity Index (CGI), Kaiser Mayer Olkin (KMO), Explanatory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA) fit indices for validity of Braden QD Scale, Cronbach's Alpha Coefficient, Inter Class Correlation (ICC), and Receiver Operating Characteristic (ROC) curve analyses for reliability were examined. In the second part of the study, Student's t test, Chi-Square test, Repeated Anova, Mann Withney U test were performed. It was determined that 54.9% of the pediatric patients in the first part of the study were female and the mean age was 3.281±3.131 years. The scale validity analyses were determined as follows; KMO: 0.619, ꭕ2: 1652.286, X2/degree of freedom: 15.47/14=1.11, p:0.347, GFI:0.96, AGFI:0.93, CFI:0.95, NFI:0.82, NNFI:0.93, RMR:0.013, SRMR:0.069, and RMSEA:0.031. In the reliability analysis, the Cronbach's Alpha value was between 0.861 and 0.879 for the items of the scale, 0.878 for the overall scale, the intraclass correlation coefficient between the observers' mean scores in the first and second evaluations was between 0.979 and 1,000, and the intra-class correlation coefficient between the observers was between 0.661 and 0.984 and was statistically significant. It was determined that the Braden QD-T showed an excellent success in predicting medical device-related pressure injuries with an Area Under the Curve (AUC) of 1.000 (95% CI; 0.94-1.00). The Cut-off Value for the total score of the scale was found to be 12.00. (Sensitivity= 100.00% (95% CI; 0.76-1.00); Specificity= 100.00% (95% CI (93.6-100.00)). In the second stage of the study, it was found that the mean age of the children was 2.9±2.5 years in the intervention group, 3.4±2.7 years in the control group 1, and 3.3±2.9 in the control group 2. It was observed that the number of medical device-related pressure injuries in children in the intervention group was 3 on day 7 and 4 on day 14. These figures were 7 days on day 7 and 14 on day 14 in the control group 1 and 5 on day 7 and 10 on day 14 in the control group 2. It has been determined that Braden QD-T Scale is a valid and reliable risk assessment tool for Turkish society. The care package is effective in preventing medical device-related pressure injuries.