According to Gram Research analysis, a structured 6-week nursing education program increased pressure injury prevention knowledge from 81% to 97% and resulted in 94% of patient care plans documenting evidence-based prevention strategies. The training covered seven key prevention methods including patient repositioning, skin assessments, and nutritional support, with nearly all care plans including repositioning instructions and Braden Scale assessments after the intervention.
Pressure sores—painful wounds that develop from sitting or lying in one position too long—are a major problem in assisted living facilities for seniors. Researchers tested whether teaching nurses better prevention methods would help. Eleven nurses at a rehabilitation facility completed training on how to spot early skin damage, reposition patients regularly, and use special assessment tools. After the training, nurses’ knowledge scores jumped from 81% to 97%, and nearly all patient care plans included proper prevention strategies. This shows that focused education can significantly improve how well facilities protect vulnerable older adults from these serious injuries.
Key Statistics
A 2026 quality improvement study of 11 nurses at an assisted living facility found that structured education on pressure injury prevention increased nursing knowledge scores from 80.7% to 97.4%, a gain of 16.7 percentage points.
Following a 6-week evidence-based training program, 94% of patient care plans at the facility documented pressure injury prevention strategies, with 100% including repositioning instructions and Braden Scale assessments.
In the study of 35 audited care plans after nursing education, 97% documented skin assessments, 91% included incontinence care plans, and 85% addressed nutritional support for pressure injury prevention.
The AHRQ Pressure Injury Prevention Toolkit training resulted in all 11 participating nurses achieving knowledge scores above 90% on the Pressure Ulcer Knowledge Test, compared to baseline scores averaging 80.7%.
The Quick Take
- What they studied: Whether teaching nurses a structured program about pressure injury prevention would improve their knowledge and how well they document prevention care for elderly patients.
- Who participated: Eleven nurses working in a rehabilitation unit at an assisted living facility, plus 35 patient care plans that were reviewed after the training.
- Key finding: Nurse knowledge about pressure injury prevention increased from 80.7% to 97.4% after the training program. Additionally, 94% of patient care plans documented proper prevention strategies after the intervention.
- What it means for you: If you have an elderly loved one in assisted living, this research suggests that facilities using structured nursing education programs are more likely to prevent painful pressure sores. Ask your facility whether staff receive regular training on pressure injury prevention.
The Research Details
This was a quality improvement project—a type of research designed to test whether changes to how a facility operates actually work better. The researchers gave 11 nurses at an assisted living facility a 6-week training program using materials from the Agency for Healthcare Research and Quality (AHRQ), a trusted government health organization. The training covered seven key topics: how to use the Braden Scale (a tool that predicts pressure injury risk), how to examine skin carefully, how often to move patients, nutrition’s role in skin health, special mattresses and cushions, how to classify pressure injuries if they occur, and how to create personalized care plans.
Before and after the training, researchers measured how much the nurses knew using a test called the Pressure Ulcer Knowledge Test (PUKT). They also reviewed 35 patient care plans after the training to see whether nurses were actually documenting all the prevention strategies they learned about. This approach—measuring knowledge before and after, plus checking whether the knowledge was being used in real patient care—gives a complete picture of whether the training actually changed practice.
Pressure injuries are serious problems in elderly care. They’re painful, expensive to treat, and can lead to infections. Older adults with limited mobility are especially vulnerable. Simply having prevention guidelines isn’t enough—nurses need to understand why these strategies matter and how to use them correctly. This study shows that targeted education can bridge that gap between knowing what to do and actually doing it in daily patient care.
This study has several strengths: it measured knowledge objectively using a validated test, it checked whether knowledge translated into actual practice changes by auditing care plans, and it used evidence-based materials from a respected government health agency. However, the study was relatively small (11 nurses) and involved only one facility, so results may not apply everywhere. There was no comparison group of nurses who didn’t receive training, which would have strengthened the findings. The study also didn’t track whether fewer pressure injuries actually occurred in patients—it only measured whether prevention strategies were documented.
What the Results Show
The training program dramatically improved nurses’ knowledge. Before the workshops, nurses scored an average of 80.7% on the Pressure Ulcer Knowledge Test. After completing the 6-week program, their average score jumped to 97.4%—a gain of 16.7 percentage points. This shows that the structured education successfully taught nurses the information they needed.
When researchers reviewed patient care plans after the training, they found that 94% included documented prevention strategies—meaning the nurses were actually using what they learned. Specific prevention strategies appeared in care plans at these rates: 100% included repositioning instructions (moving patients regularly), 100% used the Braden Scale assessment, 97% documented skin assessments, 91% included incontinence care plans, and 85% addressed nutritional support. These high percentages suggest the training motivated nurses to document their prevention efforts consistently.
The comprehensive nature of the training—covering seven different prevention strategies—appears important. The fact that all care plans included repositioning and Braden Scale use suggests these were the most successfully implemented strategies. The slightly lower rate for nutritional support (85%) suggests this aspect of prevention may need additional emphasis or resources. The high rates for skin assessments and incontinence care indicate nurses understood the connection between skin health and moisture management.
This research aligns with existing evidence showing that education improves nursing practice in long-term care settings. Previous studies have shown that pressure injury prevention requires multiple strategies working together—not just one approach. This study’s use of the AHRQ toolkit represents current best practices, as these materials are based on the strongest available evidence. The improvement in both knowledge and documentation is consistent with research showing that when nurses understand the ‘why’ behind prevention strategies, they’re more likely to implement them consistently.
The study didn’t include a control group of nurses who didn’t receive training, so we can’t be completely certain the improvements came from the training rather than other factors. The sample was small—only 11 nurses at one facility—so these results may not apply to all assisted living facilities or different types of healthcare settings. The study measured knowledge and documentation but didn’t track whether actual pressure injury rates decreased in patients, which would be the ultimate proof of success. The 6-week timeframe is relatively short, so we don’t know whether nurses maintained this high level of knowledge and practice over months or years. Finally, the study didn’t measure whether different nurses benefited differently from the training or whether some strategies were easier to implement than others.
The Bottom Line
Assisted living facilities should implement structured, evidence-based education programs for nursing staff focused on pressure injury prevention. The AHRQ Pressure Injury Prevention Toolkit appears effective and should be considered as a resource. Facilities should measure both staff knowledge and actual practice changes (through care plan audits) to ensure training translates into better patient care. Confidence level: Moderate to High—this approach is supported by this study plus existing evidence about education improving healthcare quality.
Administrators and quality improvement leaders at assisted living facilities and rehabilitation units should prioritize this type of training. Nursing staff will benefit from clearer guidance on prevention strategies. Family members of elderly relatives in assisted living should ask whether their facility provides regular pressure injury prevention training. Patients with limited mobility are the primary beneficiaries. Healthcare policymakers should consider supporting widespread adoption of evidence-based prevention education.
Knowledge improvements appeared immediately after the 6-week training program. Documentation improvements were evident when care plans were reviewed shortly after training completion. However, sustaining these improvements likely requires ongoing reinforcement—annual refresher training or monthly reminders would probably help maintain high performance over time. Actual reduction in pressure injury rates would take longer to measure, likely several months to a year.
Frequently Asked Questions
How can nursing homes prevent pressure sores in elderly patients?
Research shows that comprehensive staff training on seven prevention strategies—including regular repositioning, skin assessments, nutrition support, and using assessment tools like the Braden Scale—significantly improves prevention. A 2026 study found this approach increased prevention documentation from baseline to 94% of care plans.
Does training nurses actually reduce pressure injuries in assisted living?
Structured education improves nursing knowledge and documentation of prevention strategies. While this study didn’t measure actual pressure injury rates, the dramatic increase in knowledge (81% to 97%) and prevention strategy documentation suggests patient outcomes should improve with consistent implementation.
What should I ask my assisted living facility about pressure sore prevention?
Ask whether staff receive regular training on pressure injury prevention, whether they use the Braden Scale to assess risk, and how often patients are repositioned. Request to review your loved one’s care plan to verify it documents these prevention strategies.
How long does it take to see results from pressure injury prevention training?
Staff knowledge and documentation improvements appeared within the 6-week training period in this study. However, sustaining improvements requires ongoing reinforcement. Actual reduction in pressure injuries typically takes several months to measure.
What is the Braden Scale and why is it important?
The Braden Scale is a tool that helps nurses identify which patients are at highest risk for pressure injuries by assessing factors like mobility, moisture, and nutrition. Using it consistently—as 100% of care plans did after training—ensures at-risk patients receive appropriate prevention strategies.
Want to Apply This Research?
- If you’re a caregiver for an elderly relative, track skin condition weekly by photographing any concerning areas and noting the date. Use a simple scale: 1=normal skin, 2=redness that doesn’t go away, 3=broken skin. Share this log with facility staff to ensure consistent monitoring.
- For facility staff using a care management app: Set daily reminders to document repositioning times, Braden Scale scores, and skin assessment findings. Create a checklist within the app that includes all seven prevention strategies so nothing gets missed during care planning.
- Establish a monthly audit process where a designated staff member reviews 5-10 random care plans to verify all prevention strategies are documented. Track the percentage of compliant care plans over time. If compliance drops below 90%, schedule a refresher training session. Use this data to identify which prevention strategies need more emphasis.
This research describes a quality improvement project at one assisted living facility and should not be considered medical advice. Results may not apply to all healthcare settings. Pressure injury prevention requires individualized assessment by qualified healthcare professionals. If you or a loved one has concerns about pressure injuries or skin health, consult with a healthcare provider or dermatologist. This article is for educational purposes and does not replace professional medical guidance.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.