Trauma nurses' experience of repositioning practice for trauma patients: a qualitative descriptive study

Authors

  • Abdulkareem S. Iblasi Assistant Professor, College of Health Science – Nursing Department, Buraimi University, Al Buraimi, Oman.  https://orcid.org/0000-0003-3360-1462
    • Conceptualization
  • Yupin Aungsuroch Associate Professor, Faculty of Nursing, Chulalongkorn University Bangkok, Thailand. https://orcid.org/0000-0001-9205-1814
    • I Gede Juanamasta Nursing Program, STIKes Wira Medika Bali, Indonesia. https://orcid.org/0000-0002-5445-7861
      • Ghassan Watffa Geriatric consultant & Director of Performance and Outcomes , King Saud Medical City, Riyadh First Health Cluster, Riyadh, Saudi Arabia. 
        • Yousef Al Omran Family Medicine Consultant & Chief Organizational Development Officer, King Saud Medical City, Riyadh, Saudi Arabia. 
          • Batla Al Shammari Associated Nursing Officer, King Saud Medical City, Riyadh, Saudi Arabia.

            DOI:

            https://doi.org/10.15649/cuidarte.4324

            Keywords:

            Emergency service, Hospitals, Intensive Care Units, nurse administrators, Policy Brief, Pressure Ulcer

            Abstract

            Highlights

            • Trauma nurses face several challenges in implementing repositioning, including unclear policies, delays in medical decision, and high workloads.
            • Teamwork, clearly defined hospital policies, managerial follow-up, and timely medical decisions significantly influence nurses’ willingness and ability to perform repositioning.
            • Even when nurses decide to reposition patients, a lack of skills or proper equipment can hinder effective implementation.
            • The study recommends enhancements to hospital policies and support systems to help trauma nurses prevent pressure ulcers through consistent repositioning practices.

            Introduction: Clinical evidence indicates that the low frequency of repositioning among trauma nurses contributes to pressure ulcers during hospitalization.    Objective: This study aimed to understand how trauma nurses address the need for repositioning patients in an emergency room and intensive care unit in Saudi Arabia. Materials and Methods: A qualitative descriptive design was employed, and the study was reported in accordance with COREQ guidelines and checklist. Semi-structured interviews were conducted with nurses to explore how they interact with the need for repositioning patients. Rigor was ensured using the criteria established by Lincoln and Guba. Results: Fifteen nurses from a large government hospital in Saudi Arabia participated in the study. The findings revealed that the policy's clarity, the presence of teamwork, and the level of managerial follow-up influenced nurses' decisions to proceed and perform repositioning. This procedure is often omitted due to delays in medical decision-making and workload. After deciding to proceed, factors such as nursing skill and the availability of the equipment influence repositioning practice. Discussion: Clear policies, timely medical decisions, teamwork, manageable workloads, and managerial follow-up are critical in nurses’ decisions to perform or delay patient repositioning. After deciding to proceed, nurses face a second critical step: assessing their abilities, equipment availability, and the patient’s needs. Even with the intent to reposition, perceived skill gaps and inadequate equipment can significantly reduce the likelihood of completing the procedure.  Conclusions:  Hospitals should support the processes by improving policies and the care system for trauma patients. Repositioning is the cornerstone of pressure ulcer prevention among trauma patients; therefore, work system-level changes are needed to ensure compliance.

            How to cite this article: Iblasi Abdulkareem S, Aungsuroch Yupin, Juanamasta I Gede, Watffa Ghassan, Al Omran Yousef, Al Shammari Batla. Trauma nurses' experience of repositioning practice for trauma patients: a qualitative descriptive study. Revista Cuidarte. 2025;16(3):e4324. https://doi.org/10.15649/cuidarte.4324

            Author Biographies

            • Abdulkareem S. Iblasi, Assistant Professor, College of Health Science – Nursing Department, Buraimi University, Al Buraimi, Oman. 

              Assistant Professor, College of Health Science – Nursing Department, Buraimi University, Al Buraimi, Oman. 

            • Yupin Aungsuroch, Associate Professor, Faculty of Nursing, Chulalongkorn University Bangkok, Thailand.

              Associate Professor, Faculty of Nursing, Chulalongkorn University Bangkok, Thailand.

            • I Gede Juanamasta, Nursing Program, STIKes Wira Medika Bali, Indonesia.

              Nursing Program, STIKes Wira Medika Bali, Indonesia.

            • Ghassan Watffa, Geriatric consultant & Director of Performance and Outcomes , King Saud Medical City, Riyadh First Health Cluster, Riyadh, Saudi Arabia. 

              Geriatric consultant & Director of Performance and Outcomes , King Saud Medical City, Riyadh First Health Cluster, Riyadh, Saudi Arabia. 

            • Yousef Al Omran, Family Medicine Consultant & Chief Organizational Development Officer, King Saud Medical City, Riyadh, Saudi Arabia. 

              Family Medicine Consultant & Chief Organizational Development Officer, King Saud Medical City, Riyadh, Saudi Arabia. 

            • Batla Al Shammari, Associated Nursing Officer, King Saud Medical City, Riyadh, Saudi Arabia.

              Associated Nursing Officer, King Saud Medical City, Riyadh, Saudi Arabia.

            References

            World Health Organization. Global status report on road safety 2015: World Health Organization. [Internet] 2015 [Cited 2020 Jan 20] Available from: https://www.who.int/publications/i/item/9789241565066

            Abukhashabah E, Summan A, Balkhyour M. Occupational accidents and injuries in construction industry in Jeddah city. Saudi J Biol Sci. 2020;27(8):1993-8. https://doi.org/10.1016/j.sjbs.2020.06.033

            Al-Naami MY, Arafah MA, Al-Ibrahim FS. Trauma care systems in Saudi Arabia: an agenda for action. Ann Saudi Med. 2010;30(1):50-8. https://doi.org/10.4103/0256-4947.59374

            Rafiei H, Abdar ME, Iranmanesh S, Lalegani H, Safdari A, Dehkordi AH. Knowledge about pressure ulcer prevention, classification and management: A survey of registered nurses working with trauma patients in the emergency department. International Journal of Orthopaedic and Trauma Nursing. 2014;18(3):135-42. https://doi.org/10.1016/j.ijotn.2014.03.004

            Ham HW, Schoonhoven LL, Schuurmans MMJ, Leenen LLP. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department. International emergency nursing. 2017;30:13-9. https://doi.org/10.1016/j.ienj.2016.05.005

            Baldwin KM, Ziegler SM. Pressure ulcer risk following critical traumatic injury. Journal of Orthopaedic Nursing. 1998;2(4):234. https://doi.org/10.1016/S1361-3111(98)80058-7

            Cyriacks B, Spencer C. Reducing HAPI by cultivating team ownership of prevention with budget-neutral turn teams. Medsurg Nursing. 2019;28(1):48-52. Retrieved from https://www.proquest.com/openview/dd9dc13fc3f9b8e9ebc9f38e0b97da49/1?pq-origsite=gscholar&cbl=30764

            Wu T, Wang S-T, Lin P-C, Liu C-L, Chao Y-FC. Effects of using a high-density foam pad versus a viscoelastic polymer pad on the incidence of pressure ulcer development during spinal surgery. Biological research for nursing. 2011;13(4):419-24. https://doi.org/10.1177/1099800410392772

            KSMC. Wound Care Commitee Yearly Report - King Saud Medical City. King Saud Medical City - Total Quality Management; [Internet] 2019. [Cited 2019 Oct 12] Available from: https://medicalcity.ksu.edu.sa/en/page/annual-reports

            European Pressure Ulcer Advisory Panel NPIPaPPPIA. Prevention and Treatment of Pressure Ulcers/ Injuries: Clinical Prcatice Guideline. The International Guideline. EPUAP/NPIAP/PPPIA EHE, editor: European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance; [Internet] 2019. [Cited 2019 May 15] Available from: https://internationalguideline.com/2019

            Gefen A. The future of pressure ulcer prevention is here: detecting and targeting inflammation early. EWMA J. 2018;19(2):7-13. https://ttsafemed.dk/wp-content/uploads/Pressure-ulcer-prevention-article-about-study-by-Amit-Gefen.pdf

            Gefen A. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 2. Nursing Standard. 2009;23(46):40-4. https://www.researchgate.net/publication/306382011_Reswick_and_Rogers_pressure-time_curve_for_pressure_ulcer_risk_Part_2

            Huang L, Woo KY, Liu L-B, Wen R-J, Hu A-L, Shi C-G. for preventing pressure ulcers: a meta-analysis. Advances in skin&wound care. 2015;28(6):267-73. https://doi.org/10.1097/01.ASW.0000463905.69998.0d

            Mervis JS, Phillips TJ. Pressure ulcers: prevention and management. Journal of the American Academy of Dermatology. 2019;81(4):893-902. https://doi.org/10.1016/j.jaad.2018.12.068

            Ministry of Health [MOH]. Pressure ulcer protocol (prevention and treatment) Ministry of Health Kingdom of Saudi Arabia. Directorate GN, editor: Ministry of Health - Kingdome of Saudi Arabia [Internet] 2019 [Cited 2019 Jul 29] Available from: https://www.moh.gov.sa/en/HealthAwareness/EducationalContent/Diseases/Dermatology/Pages/010.aspx

            EPUAP/NPIAP/PPPIA. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/ Injuries: Clinical Practice Guideline. The International Guideline. EPUAP/NPIAP/PPPIA EHE, editor: European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance; [Internet] 2019. [Cited 2020 Feb 26] Available from: http://51.15.64.204/static/pdfs/Quick_Reference_Guide-10Mar2019.pdf

            Avsar P, Patton D, O'Connor T, Moore Z. Do we still need to assess nurses' attitudes towards pressure ulcer prevention? A systematic review. Journal of Wound Care. 2019;28(12):795–806. https://doi.org/10.12968/jowc.2019.28.12.795

            Iblasi A, Aungsuroch Y, Gunwan J. Factors affecting repositioning policy compliance: an integrative review. Frontiers of Nursing. 2021;8(1):7-22. https://doi.org/10.2478/fon-2021-0002

            Kozier-Erbs AB, Shirlee S, Geralyn F. Fundamentals of Nursing: Concepts, Process, and Practice. USA: Pearson Education; 2016.

            Knibbe NE, Zwaenepoel E, Knibbe HJ, Beeckman D. An automatic repositioning system to prevent pressure ulcers: a case series. Br J Nurs. 2018;27(6):S16-S22. https://doi.org/10.12968/bjon.2018.27.6.S16

            Taylor C, Lillis C, LeMone P, LeBon M. Procedure checklists to accompany fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott; 2001.

            Rasmussen CD, Larsen AK, Holtermann A, Sogaard K, Jorgensen MB. Adoption of workplaces and reach of employees for a multi-faceted intervention targeting low back pain among nurses' aides. BMC Med Res Methodol. 2014;14(1):60. https://doi.org/10.1186/1471-2288-14-60

            Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. https://doi.org/10.1093/intqhc/mzm042

            Beck CT. Qualitative research: the evaluation of its credibility, fittingness, and auditability. West J Nurs Res. 1993;15(2):263-6. https://doi.org/10.1177/019394599301500212

            Mihas P. Qualitative data analysis. Oxford Research Encyclopedia of Education;2019.

            Moerman GA. Probing behaviour in open interviews: A field experiment on the effects of probing tactics on quality and content of the received information. Amsterdam: VU University Amsterdam 2010.

            Bryman A, Burgess B. Analyzing qualitative data: Routledge; 2002.

            Safian S. Essentials of health care compliance. 1, editor. Clifton Park, N.Y: Delmar, Cengage Learning; 2009.

            Iblasi A, Aungsuroch Y, Juanamasta IG, Watffa G, Al Omran Y, Al Shammari B. Repositioning Practice for trauma patients: A phenomenological study. Mendeley Data V1; 2024. https://doi.org/10.17632/zvd2thrh92.1

            Health and biomedical Research Policy in King Fahad Medical City, [Internet] 2018. [Cited 2019 Jul 20]. Available from: https://www.kfmc.med.sa/EN/Research/Pages/Policies.aspx

            Ajzen I. Theory of Planned Behavior Diagram, [Internet] 2019. [Cited 2019 May 30]. Available from: https://people.umass.edu/aizen/tpb.diag.html

            Saeedifar ES, Memariyan R, Akhyani M, Fatahi S, Ghelichkhani F. Who to assess pain using Orem Self-Care Model. International Journal of Medical Investigation. 2018;7(1):33-8. https://intjmi.com/browse.php?a_id=299&sid=1&slc_lang=en

            Gunawan J, Aungsuroch Y. Managerial competence of first‐line nurse managers: A concept analysis. International journal of nursing practice. 2017;23(1):e12502. https://doi.org/10.1111/ijn.12502

            Iblasi AS, Aungsuroch Y, Gunawan J, Juanamasta IG, Carver C. Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis. SAGE Open Nurs. 2022;8. https://doi.org/10.1177/23779608221106443

            Wiggermann N. Biomechanical Evaluation of a Bed Feature to Assist in Turning and Laterally Repositioning Patients. Hum Factors. 2016;58(5):748-57. https://doi.org/10.1177/0018720815612625

            Knibbe, Zwaenepoel E, Knibbe HJ, Beeckman D. An automatic repositioning system to prevent pressure ulcers: a case series. British Journal of Nursing. 2018;27(6):S16—S22. https://doi.org/10.12968/bjon.2018.27.6.S16

            Krapfl LA, Langin J, Pike CA, Pezzella P. Does Incremental Positioning (Weight Shifts) Reduce Pressure Injuries in Critical Care Patients? J Wound Ostomy Continence Nurs. 2017;44(4):319-23. https://doi.org/10.1097/WON.0000000000000340

            Iblasi AS, Aungsuroch Y, Gunawan J, Juanamasta IG. Clarifying repositioning in a pressure injury context: A scoping review. Pacific Rim International Journal of Nursing Research. 2022;27(1):34-49. https://doi.org/10.60099/prijnr.2023.260331

            MOH S. Pressure ulcer protocol (prevention and treatment) Ministry of Health Kingdom of Saudi Arabia: Ministry of Health - Kingdome of Saudi Arabia; [Internet] 2019. [Cited 2021 March 07] Available from: https://www.moh.gov.sa/en/awarenessplateform/VariousTopics/Pages/Bedsores.aspx

            Downloads

            Published

            2025-09-01

            How to Cite

            1.
            Iblasi AS, Aungsuroch Y, Juanamasta IG, Watffa G, Al Omran Y, Al Shammari B. Trauma nurses’ experience of repositioning practice for trauma patients: a qualitative descriptive study. Revista Cuidarte [Internet]. 2025 Sep. 1 [cited 2026 May 13];16(3). Available from: https://revistas.udes.edu.co/cuidarte/article/view/4324

            Downloads

            Download data is not yet available.

            Issue

            Section

            Investigation Article

            Categories

            Similar Articles

            1-10 of 535

            You may also start an advanced similarity search for this article.