Abdominal Massage and Range-of-motion Exercise in Enterally Fed ICU Patients With Pressure Injuries

The purpose of this study is to evaluate whether two nursing interventions, lower abdominal massage and range-of-motion (ROM) exercises (gentle movements of the arm and leg joints), affect the healing of pressure injuries (bed sores) in intensive care patients who are fed through a tube (enteral nutrition). Intensive care patients often stay in bed for long periods and are at high risk of pressure injuries. Adequate nutrition is important for wound healing, but tube-fed patients often have digestive problems such as constipation, vomiting, bloating, or food remaining in the stomach, which can interrupt feeding. The main question this study will address is: Compared with routine care, do lower abdominal massage or ROM exercises affect digestive tolerance, nutritional markers, and pressure injury healing in tube-fed intensive care patients? The researchers hypothesize that lower abdominal massage may reduce digestive problems and support uninterrupted feeding, and that ROM exercises may support circulation and tissue healing. Both effects may, in turn, support pressure injury healing. Adult patients who have a pressure injury and receive enteral nutrition in the intensive care units of a state hospital in Türkiye will be randomly assigned to one of three groups: * Group 1: lower abdominal massage in addition to routine care * Group 2: ROM exercises in addition to routine care * Control group: routine care only The interventions will be applied for 15 minutes once a day for 7 days. Digestive tolerance (bowel movements, gastric residual volume, nausea, vomiting, abdominal distension), serum albumin, and pressure injury healing (Pressure Ulcer Scale for Healing, PUSH) will be monitored daily. Detailed Description This is a three-arm, parallel-group, randomized controlled experimental study planned for the intensive care units of a secondary-level state hospital in Türkiye. Patients who meet the eligibility criteria will be allocated to lower abdominal massage, ROM exercise, or routine care using a computer-generated randomization list (Microsoft Excel). The sample size will be calculated with G\*Power before data collection (planned minimum: 90 patients; effect size 0.20, alpha 0.05, 95% confidence level). Interventions: Lower abdominal massage (15 minutes: superficial effleurage, palm petrissage, fingertip vibration, closing effleurage; clockwise along the colon, with hands warmed in liquid paraffin) will be performed by an intensive care nurse. ROM exercises (flexion-extension, abduction-adduction and rotation of the upper and lower limb joints, with the patient supine; 3 repetitions per movement, held 30 seconds at the point of resistance; 15 minutes in total) will be performed after the researchers receive ROM training from a physiotherapist. The control group will receive routine intensive care only (nasogastric tube position checks, monitoring of gastric residual volume, defecation, nausea and vomiting, daily Braden Scale assessment, two-hourly repositioning, and stage-appropriate topical wound care). Data will be collected daily at 10:00 using a Patient Information Form and an Intervention/Control Group Patient Monitoring Form. Gastric residual volume will be assessed between 02:00 and 04:00 when feeding is paused. Planned analysis: Normality will be assessed with skewness and kurtosis values (±3). Between-group comparisons will use chi-square/Fisher\'s exact test, one-way ANOVA or Kruskal-Wallis test with post hoc tests. Within-group changes over time will use repeated-measures ANOVA, Friedman test, or Cochran\'s Q test as appropriate (significance p\<0.05).