Investigating education needs in prone positioning care, an interview study (Pronetection study)

Critically ill patients with moderate to severe acute respiratory distress syndrome (ARDS) - an acute inflammatory lung injury - are often placed in the prone position to improve gas exchange and oxygen delivery. The efficacy of prone ventilation is due in part to reversal of atelectasis, improved homogeneous lung ventilation, alveolar recruitment, minimization of ventilation-induced barotrauma, and drainage of pulmonary secretions. In the prone position, there is an increased risk of developing PU because the patient remains in this position for up to 16 hours or more without being able to turn on his or her side as easily as a patient in the supine position. In the prone position, more bony areas and thinner soft tissue masses (e.g., the forehead and chin) are exposed to the sustained weight of the body than in the supine position. Areas most affected by sustained pressure and shear forces in the prone position include the face, chest, genitalia and lower rib margins, iliac crest, and anterior bony prominences (knee, tibial crest, dorsum of foot), including pressure ulcers associated with medical devices, particularly due to fastening devices and endotracheal tubes.

The objectives of this study are (1) to explore the education and training needs of critical care nurses regarding prone positioning, (2) to investigate the conditions for effective implementation in a critical care facility. This study is a qualitative study design with semi-structured, in-depth interviews. The study will be conducted in Belgium and in Sweden. The results of a comprehensive review and gap analysis from 2021, together with the results of the interviews in this study, will form the basis for the development of the training and education package. Participants will be recruited from the following settings:

• Karlskoga lasarett, Karlskoga, Sweden
• Nyköping lasarett, Nyköping, Sweden
• Örebro university hospital, Örebro, Sweden
• Brussels University Hospital, Belgium
• Ghent University Hospital, Belgium