Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Kara S. Koschmann


Doctor of Nursing Practice


Background: The prevalence of pressure injuries (PIs) across the country remains significantly higher in dark-skinned individuals compared to light-skinned individuals. As most PIs are preventable, hospitals are required to have protocols and guidelines in place for the prevention and assessment of PIs. Hospitals lack evidence-based guidelines for assessing skin in darkly pigmented individuals.

Local Problem: A large midwestern health system identified this gap as a priority for quality improvement (QI). The purpose of this QI project was to evaluate baseline nursing knowledge and confidence regarding the assessment and identification of PIs among all skin tones, assess the applicability of current evidence-based PI guidelines, and improve nursing knowledge and confidence in PI assessment and identification.

Methods: A QI project provided PI-related education to 45 bedside nurses at local 680-bed hospital. Educational content via a 15- minute PowerPoint was given over a 6-week period.

Interventions: Utilizing evidence-based research and nursing knowledge, a skin assessment tool and PowerPoint presentation was created to help improve identification and assessment of PIs. Posters with the acronym P.I.G.M.E.N.T. were displayed throughout the nursing break room. Survey questionnaires were distributed pre- and post-educational sessions.

Results: A total of 45 hospital RNs received the educational content, and 29 RNs completed both pre-education and post-education surveys. After comparing pre- and post-survey results, a significant increase in nursing confidence of assessing for PIs in darkly pigmented skin tones was observed and a moderate increase in nursing confidence of identifying PIs in lightly pigmented skin was observed. A moderate increase in nursing knowledge of identifying PIs in darkly pigmented skin was observed.

Conclusion: Through education, the long-term goal of this QI project is to see a decrease in the overall incidence of PIs in individuals across all skin tones. Through an educational PowerPoint presentation and the creation of a skin assessment tool, an improvement in nursing knowledge and confidence in identifying PIs among all skin tones was seen.

Available for download on Thursday, May 01, 2025