SCOPE REVIEW PROTOCOL

CAREGIVERS’ KNOWLEDGE ABOUT PRESSURE INJURY PREVENTION: A SCOPING REVIEW PROTOCOL

 

CONOCIMIENTOS DE LOS CUIDADORES SOBRE LA PREVENCIÓN DE LAS LESIONES POR PRESIÓN: UM PROTOCOLO DE REVISIÓN DEL ALCANCE

 

CONHECIMENTO DE CUIDADORES SOBRE PREVENÇÃO DE LESÃO POR PRESSÃO: PROTOCOLO DE REVISÃO DE ESCOPO

 

 

https://doi.org/10.31011/reaid-2025-v.99-n.2-art.2533

 

1Maria Clara Santana da Silva

2Eugênio Barbosa de Melo Júnior

3Fernanda Valéria Silva Dantas Avelino

 

1Universidade Federal do Piauí, Teresina, Brazil. ORCID: https://orcid.org/0000-0003-0927-1918

2Universidade Federal do Piauí, Teresina, Brazil. ORCID: https://orcid.org/0000-0002-0444-2960

3Universidade Federal do Piauí, Teresina, Brazil. ORCID: https://orcid.org/0000-0002-9835-6034

 

Corresponding Author

Maria Clara Santana da Silva

Rua Dr. Epifánio Carvalho, 1391, Ininga, 3215-5558, Teresina - PI, Brazil – E-mail: clarasantanasilvaaa@gmail.com.

 

Submission: 26-03-2025

Approval: 05-04-2025

 

ABSTRACT

Objective: To map the available evidence regarding caregivers' knowledge about pressure ulcer prevention. Method: This is a scope review protocol based on the Joanna Briggs Institute, which will follow the PRISMA-Scr Checklist recommendations for study inclusion. The aim is to answer the following guiding question, based on the PCC mnemonic (Population-Concept-Context): "What is the available evidence regarding caregivers' knowledge about pressure ulcer prevention?" The search will be conducted in the following databases: BDENF, LILACS, Web of Science, CINAHL, MEDLINE via PubMed, and SCOPUS. Grey literature will be searched in the CAPES Theses and Dissertations Catalog. As for the eligibility criteria, studies that answer the research question and are available in full, with no time or language restrictions, will be included, while editorials and other studies that do not address the guiding research question or the topic will be excluded. Results: The results of this review will provide a better understanding of the aspects related to caregivers' knowledge and profile regarding pressure ulcer prevention, their target audience, as well as other aspects related to pressure ulcer prevention, in order to disseminate evidence that is underexplored in the scientific literature. Conclusion: It is expected that studies will be identified, which highlight aspects related to caregivers' knowledge about pressure ulcer prevention, pointing out possible knowledge gaps to establish priorities for future research.

Keywords: Pressure Ulcer; Patient Safety; Quality of Health Care.

 

RESUMEN

Objetivo: mapear las evidencias disponibles sobre el conocimiento de los cuidadores acerca de la prevención de lesiones por presión. Método: Se trata de un protocolo de revisión de alcance fundamentado por el Joanna Briggs Institute y que seguirá las recomendaciones del Checklist PRISMA-Scr para la inclusión de estudios. Se pretende responder a la siguiente pregunta orientadora, basada en el mnemónico PCC (Población-Concepción-Contexto): “¿Cuáles son las evidencias disponibles sobre el conocimiento de los cuidadores acerca de la prevención de lesiones por presión?”. La búsqueda se realizará en las bases de datos BDENF, LILACS, Web of Science, CINAHL, MEDLINE vía PubMed y SCOPUS, y la literatura gris será investigada en el Catálogo de Tesis y Disertaciones de la CAPES. En cuanto a los criterios de elegibilidad, se incluirán los estudios que respondan a la pregunta de investigación, disponibles en su totalidad, sin limitación temporal o idiomática, y se excluirán los editoriales y demás estudios que no respondan a la pregunta orientadora de la investigación o que no aborden la temática. Resultados: Los resultados de esta revisión permitirán una mejor comprensión sobre los aspectos relacionados con el conocimiento y el perfil de los cuidadores sobre la prevención de lesiones por presión, su público objetivo, así como otros aspectos relacionados con la prevención de las lesiones por presión, con el fin de divulgar evidencias poco exploradas en la literatura científica. Conclusión: Se espera identificar estudios que evidencien aspectos relacionados con el conocimiento de los cuidadores sobre la prevención de lesiones por presión, señalando posibles vacíos de conocimiento, con miras a establecer prioridades para futuras investigaciones.

Palabras Clave: Úlcera por Presión; Seguridad del Paciente; Calidad de la Atención de Salud.

 

RESUMO

Objetivo: mapear as evidências disponíveis acerca do conhecimento de cuidadores sobre a prevenção de lesão por pressão. Método: Trata-se de um protocolo de revisão de escopo fundamentado pelo Joanna Briggs Institute e que seguirá as recomendações do Checklist PRISMA-Scr para inclusão de estudos. Pretende-se responder à seguinte questão norteadora, baseada no mneumônico PCC (População-Conceito-Contexto): “Quais são as evidências disponíveis acerca do conhecimento de cuidadores sobre a prevenção de lesão por pressão?”. A busca será realizada nas bases de dados BDENF, LILACS, Web of Science, CINAHL, MEDLINE via PubMed e SCOPUS, e a literatura cinzenta será pesquisada no Catálogo de Teses e Dissertações da CAPES. Quanto aos critérios de elegibilidade, serão incluídos estudos que respondam à pergunta de pesquisa, disponíveis na íntegra, sem delimitação temporal ou idiomática, e serão excluídos editoriais e demais estudos que não respondam à questão norteadora da pesquisa ou que não abordem a temática. Resultados: Os resultados desta revisão permitirão melhor compreensão acerca dos aspectos relacionados ao conhecimento e perfil de cuidadores sobre a prevenção de LP, seu público-alvo, bem como demais aspectos relacionados à prevenção das lesões por pressão, a fim de divulgar evidências pouco exploradas na literatura científica. Conclusão: Espera-se identificar estudos que evidenciem aspectos relacionados ao conhecimento de cuidadores sobre a prevenção de lesões por pressão, apontando possíveis lacunas de conhecimento, com vistas a elencar prioridades para pesquisas futuras.

Palavras-Chave: Úlcera por Pressão; Segurança do Paciente; Qualidade da Assistência à Saúde.

 

INTRODUCTION

Pressure Injuries (PIs) are a public health problem caused by the wear and tear of the skin and underlying tissues, which occur most frequently in bony prominences due to intense and/or prolonged pressure, associated or not with shearing(1). PIs are classified into stages, according to the depth, time of exposure and intensity of pressure of the injured tissue, and are influenced by coexisting conditions, such as type 2 Diabetes Mellitus and Systemic Arterial Hypertension(2).

 PI prevention is part of the sixth national Patient Safety goal established by the Brazilian Ministry of Health, and in the hospital environment, from the third stage onwards, they are recognized as “never events”, or events that should never happen in health services and that persist for several reasons, among them: the complexity of hospital environments, whose work processes favor the occurrence of errors by professionals(3,4).

 The alarming situation of PIs in Brazil was demonstrated in the national report of incidents related to health care, through notifications to the National Health Surveillance System, in which between 2014 and 2022, 1,100,352 incidents were reported, of which 223,378 represented PIs, 19,307 being stage 3 PIs and 5,769 being stage 4(5).

 The concern regarding the occurrence of PIs in Brazil and worldwide is based on the negative impact on the patient's prognosis, longer hospitalization time, increased demand for human resources and expenditures on the public health system. However, it is only possible to prevent PIs through the dissemination of information, both to health professionals, formal or informal caregivers, and to the community in general, which is one of the points of Patient Safety actions(6,7).

 Considering that prevention requires knowledge, and that in the hospital and home environment patients are accompanied by a caregiver, whether a family member, formal or informal, the importance of engaging caregivers of patients at risk for PI in preventive actions is highlighted(8). The work of caregivers reinforces the practice of care that is beneficial to the health and recovery of patients, and their engagement involves an active partnership between the various stakeholders involved in care. Therefore, they play a fundamental role in the quality of care and patient safety through preventive and health promotion practices(9).

 The construction of this protocol is based on the need to ascertain how caregivers' knowledge about PI prevention has been described in the literature, and based on the final results of the scoping review, it may be possible to provide requirements for the construction of strategies aimed at this audience and the topic, facilitating the promotion of information and health education.

 From a simple search in the literature, it was noted that there were research gaps on the topic, which instigated this research. Therefore, given the problems surrounding the occurrence of pressure ulcers and the relevance of the role of caregivers in preventing this condition, the aim is to present a scoping review protocol to map the available evidence regarding caregivers' knowledge about pressure ulcer prevention. The research question is: "What evidence is available regarding caregivers' knowledge about pressure ulcer prevention?"

 

MATERIALS AND METHOD

This protocol follows the recommendations of the Joanna Briggs Institute (JBI)(10) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-Scr)(11-12). The protocol was registered in the Open Science Framework (OSF), available at DOI:10.17605/OSF.IO/JHMYD.

 To develop the guiding research question, the PCC mnemonic was composed as follows: Population refers to caregivers; Concept to PI; and Context to the level of knowledge. In this sense, the question of this scoping review is: “What is the available evidence regarding caregivers’ knowledge about pressure injury prevention?”

 

Eligibility Criteria

Cross-sectional studies, randomized clinical trials, and systematic reviews published online in full, without time or language restrictions, will be included. Editorials, publications that do not address caregivers' knowledge about PI prevention, and publications that are not aligned with the objective or do not answer the guiding question of the research will be excluded. It is worth noting that since the research will seek to understand the knowledge of caregivers in general, it will involve all types of caregivers, whether formal, informal, family members, or spouses.

 

Search strategy

The bibliographic survey will be conducted in the following databases and bibliographic indexes: Nursing Database (BDENF) and Latin American and Caribbean Literature in Health Sciences (LILACS) from the Latin American and Caribbean Center for Health Sciences Information (BIREME), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online/National Library of Medicine (MEDLINE) via PubMed and SCOPUS. As for gray literature, this will be researched in the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CDT-CAPES).

 The search strategy will be formulated based on the Health Sciences Descriptors (DeCS)/Medical Subject Headings (MeSH), CINAHL Headings and uncontrolled descriptors, which will be combined with each other using the Boolean operators AND and OR, according to the search strategies described in Table 1.

 

Table 1 - Search strategies in databases and libraries.

DESCRIPTORS

DATABASE  

SEARCH SYNTAX

Controlled

Not controlled

Caregivers

Pressure Ulcer

Knowledge

Caregivers

Pressure Ulcer

Knowledge

Caregiver

Informal

caregiver

Informal caregivers

Family caregiver

Pressure injury

Pressure ulcers

Decubitus ulcer

Decubitus ulcers

Knowledge

Caregiver

Informal Caregiver

Informal Caregivers Pressure Ulcers Pressure Injury

BDENF e LILACS, via BVS

(mh:(Cuidadores)) OR (Cuidador) OR ("Cuidador informal") OR ("Cuidadores informais") OR ("Cuidador Familiar") AND (mh:("Úlcera por Pressão")) OR ("Úlceras por pressão") OR ("Úlcera de Decúbito") OR ("Úlceras de Decúbito") OR ("Lesão por pressão") AND (mh:(Conhecimento)) OR (Conhecimentos)

CINAHL

MH caregivers AND MH "pressure ulcer" OR "pressure injury" AND MH knowledge

MEDLINE by PubMed

(((((caregivers[MeSH Terms]) AND (caregiver)) AND ("pressure ulcer"[MeSH Terms])) OR ("pressure ulcers")) OR ("pressure injury")) AND (knowledge[MeSH Terms])

SCOPUS

( TITLE-ABS-KEY ( caregivers ) OR TITLE-ABS-KEY ( caregiver ) OR TITLE-ABS-KEY ( "informal caregiver" ) OR TITLE-ABS-KEY ( "informal caregivers" ) AND TITLE-ABS-KEY ( "pressure ulcer" ) OR TITLE-ABS-KEY ( "pressure ulcers" ) OR TITLE-ABS-KEY ( "pressure injury" ) AND TITLE-ABS-KEY ( knowledge ) )

Web of Science

(((((((ALL=(caregivers)) OR ALL=(caregiver)) OR ALL=("informal caregiver")) OR ALL=("informal caregivers")) AND ALL=("pressure ulcer")) OR ALL=("pressure ulcers")) OR ALL=("pressure injury")) AND ALL=(knowledge)

CTD -CAPES

"Úlcera por Pressão" OR "Lesão por Pressão" AND Cuidadores OR Cuidador AND Conhecimento

 

Source: Prepared by the authors, 2025.

 

Selection of sources of evidence

The search will be conducted by two independent reviewers, blindly, who will perform the initial screening based on the titles and, subsequently, by reading the abstracts, using the eligibility criteria as a guide. All identified references will be imported into the Rayyan Qatar Computing Research Institute Systems (Rayyan) platform. This is an online tool used to systematize and manage the references used in literature reviews(13). All duplicate articles will be counted only once.

 Disagreements regarding the inclusion of studies will be discussed and resolved among the reviewers, and, in cases of a tie, a third reviewer will be called in and, after reading the material in full, will break the tie to compose the final sample. The process of searching for and including studies will be explained in the final version of the scoping review and presented in a PRISMA-ScR flow diagram.

 

Data extraction

Data extracted from the studies will be collected using a data mapping form in Microsoft Word, based on the manual provided by the JBI(11). The form will be tested by two independent reviewers, using a random sample of 10% of the included studies to ensure consistency and accuracy of the instrument.

 

Data analysis and presentation

Data analysis will be conducted to identify themes and subthemes, which will be grouped and presented as a narrative. The classification of scientific evidence from the articles that make up the sample will be based on the levels of evidence established by(14). The most relevant results will be described and substantiated according to the literature, seeking to interpret their results.

 

EXPECTED RESULTS

The results of this review will allow a better understanding of aspects related to the knowledge and profile of caregivers regarding the prevention of PI, their target audience, as well as other aspects related to the prevention of pressure injuries, in order to disseminate evidence little explored in the scientific literature.

 

CONCLUSION

The development of this protocol strictly followed the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-Scr) Checklist, and is ready to be implemented, aiming to provide a summary of caregivers' knowledge about PI prevention.

 It is also expected to identify studies that highlight aspects related to caregivers' knowledge about PI prevention, pointing out possible knowledge gaps, with a view to listing priorities for future research.

 

REFERENCES

 

  1. European Pressure Ulcer Advisory Panel; National Pressure Injury Advisory Panel (NPIAP); Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline 2019. Emily Haesler: EPUAP/NPIAP/PPPIA; 2019.
  2. Ministério da Saúde (BR). Nota Técnica GVIMS/GGTES/Anvisa nº 05/2023. Práticas de Segurança do Paciente em Serviços de Saúde: prevenção de lesão por pressão [Internet]. Brasília-DF: ANVISA; 2023 [citado 2025 Mar 20]. Disponível em: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-anvisa-no-05-2023-praticas-de-seguranca-do-paciente-em-servicos-de-saude-prevencao-de-lesao-por-pressao/view.
  3. Ministério da Saúde (BR). Nota técnica GVIMS/GGTES nº 03/2017. Práticas seguras para prevenção de lesão por pressão em serviços de saúde [Internet]. Brasília-DF: ANVISA; 2017 [citado 2025 Mar 20]. Disponível em: https://antigo.anvisa.gov.br/documents/33852/271855/Nota+T%C3%A9cnica+GVIMS-GGTES+n%C2%BA+03-2017/54ec39f6-84e0-4cdb-a241-31491ac6e03e?version=1.1.
  4. Jesus MAP. et al. Incidência de lesão por pressão em pacientes internados e fatores de risco associados. Rev Baiana Enferm. 2020[citado 2025 Mar 20]. 34 (Supl). Disponível em: https://www.revenf.bvs.br/scielo.php?script=sci_arttext&pid=S2178-86502020000100341.
  5. Ministério da Saúde (BR). Boletim Segurança do Paciente e Qualidade em Serviços de Saúde nº 29: incidentes relacionados à assistência à saúde – 2014 a 2022 [Internet]. Brasília-DF: ANVISA; 2022. Disponível em: https://www.gov.br/anvisa/ptbr/centraisdeconteudo/publicacoes/servicosdesaude/boletins-e-relatorios-dasnotificacoes-de-iras-e-outros-eventos-adversos-1/BR_2014__2022.pdf.
  6. Teixeira AO. et al. Factors associated with the incidence of pressure wounds in critical patients: a cohort study. Rev. Bras. Enferm. 2022 [citado 2025 Mar 20]; 75 (6): e20210267. Disponível em: https://www.scielo.br/j/reben/a/KRbDPd6VwRpYgcQ65XC6bwR/?lang=en.
  7. World Health Organization. Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. Geneva: WHO; 2021 [citado 2025 Mar 20]. Disponível em: https://iris.who.int/bitstream/handle/10665/343477/9789240032705-eng.pdf?sequence=1.
  8. Morais L. et al. Prevalência do risco de lesão por pressão em usuários da atenção domiciliar: estudo transversal. 2023 [citado 2025 Abr 05]. 97 (4): e023206. Disponível em: https://revistaenfermagematual.com.br/index.php/revista/article/view/1706/3346.
  9. Levoy K. et al. Caregiver Engagement Enhances Outcomes Among Randomized Control Trials of Transitional Care Interventions: A Systematic Review and Meta-analysis. Med Care. 2022 [citado 2025 Mar 20]. 60 (7): 519-29. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35679175/.
  10. Joanna Briggs Institute. JBI Manual for Evidence Synthesis. Austrália: The Joanna Briggs Institute, 2020 [citado 2025 Mar 20]. Disponível em: https://jbi-global-wiki.refined.site/space/MANUAL/355599504/Downloadable+PDF+-+current+version.
  11. Peters MDJ. et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid. Synth. 2020[citado 2025 Mar 20]. 18 (10): 2119-26. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33038124/.
  12. Tricco AC. et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Lista de verificação e explicação. Ann. Intern. Med. 2018 [citado 2025 Mar 20]. 169(7): 467-73. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30178033/.
  13. Ouzzani M. et al. Rayyan-a web and mobile app   for   systematic   reviews.   Syst. Rev. 2016 [citado 2025 Mar. 20]. 5 (1): 1-10. Disponível em: https://www.researchgate.net/publication/311443509_Rayyan-a_web_and_mobile_app_for_systematic_reviews.
  14. Joanna Briggs Institute. JBI levels of evidence. 2014 [citado 2025 Mar 20]. Disponível em: https://jbi.global/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf.

Funding: This work was carried out with the support of the Piauí State Research Support Foundation – FAPEPI, Notice 003/2024.

Authorship criteria (authors' contributions)

Silva MCS, Melo Júnior EB and Avelino FVSD contributed significantly to the conception, planning, data curation, formal analysis, construction of the method and writing of the study.

Declaration of conflict of interest

 Nothing to declare.

Scientific Editor: Ítalo Arão Pereira Ribeiro. Orcid: https://orcid.org/0000-0003-0778-1447

 

Rev Enferm Atual In Derme 2025;99(2): e025057                  

 Atribuição CCBY