Abstract

Patients with spinal cord injury (SCI) are at increased risk for pressure injuries (PIs) due to impaired mobility and sensation (Wijker et al., 2025). On the SCI unit at Spaulding Rehabilitation Hospital, a recent rise in PIs prompted a quality improvement initiative focused on overnight repositioning practices. While protocol recommends repositioning every two hours, patients frequently decline, and staff report barriers to adherence.

This project aimed to identify barriers to overnight repositioning and implement an educational intervention to support nursing staff in addressing these challenges. Virginia Henderson’s Need Theory served as the theoretical framework, aligning to support patient independence and prevent complications.

An educational session was developed for the nursing and patient care assistant staff. Content included SCI pathophysiology-related pressure injury risk factors and communication strategies for engaging patients in skin care decisions. However, on implementation, it was revealed that participants were not ready to learn, and a qualitative, discussion-based approach with nurses revealed four key themes of repositioning barriers: patient knowledge gaps, contradictory messaging from providers, staffing constraints, and inter-shift tensions.

This project takes a vital first step toward addressing systemic factors that are essential for sustained improvement. Ultimately, nurse confidence and patient education are expected to enhance adherence to repositioning protocols and reduce pressure injury rates, however, future research is needed on appropriate interventions to address these associated barriers first.