Abstract
BackgroundPressure ulcer prevention is a critical patient safety indicator for acute care hospitals. An innovative pressure ulcer prevention care bundle targeting patient participation in their care was recently tested in a cluster randomised trial in eight Australian hospitals. Understanding nurses’ perspectives of such an intervention is imperative when interpreting results and translating evidence into practice. As part of a process evaluation for the main trial, this study assessed nurses’ perceptions of the usefulness and impact of a pressure ulcer prevention care bundle intervention on clinical practice.MethodsThis qualitative descriptive study involved semi-structured interviews with nursing staff at four Australian hospitals that were intervention sites for a cluster randomised trial testing a pressure ulcer prevention care bundle. Four to five participants were purposively sampled at each site. A trained interviewer used a semi-structured interview guide to question participants about their perceptions of the care bundle. Interviews were digitally recorded, transcribed and analysed using thematic analysis.ResultsEighteen nurses from four hospitals participated in the study. Nurses’ perceptions of the intervention are described in five themes: 1) Awareness of the pressure ulcer prevention care bundle and its similarity to current practice; 2) Improving awareness, communication and participation with the pressure ulcer prevention care bundle; 3) Appreciating the positive aspects of patient participation in care; 4) Perceived barriers to engaging patients in the pressure ulcer prevention care bundle; and 5) Partnering with nursing staff to facilitate pressure ulcer prevention care bundle implementation.ConclusionsOverall, nurses found the care bundle feasible and acceptable. They identified a number of benefits from the bundle, including improved communication, awareness and participation in pressure ulcer prevention care among patients and staff. However, nurses thought the care bundle was not appropriate or effective for all patients, such as those who were cognitively impaired. Perceived enablers to implementation of the bundle included facilitation through effective communication and dissemination of evidence about the care bundle; strong leadership and ability to influence staff behaviour; and simplicity of the care bundle.
Highlights
Pressure ulcer prevention is a critical patient safety indicator for acute care hospitals
Nurses spent longer responding to Awareness of the Pressure ulcer prevention care bundle (PUPCB) and its similarity to current practice All nursing staff were aware of the INTACT trial happening on their ward
Nurses described their perceptions of the intervention (PUPCB), including their understanding of what it involved and how they thought it compared with their current practice
Summary
Pressure ulcer prevention is a critical patient safety indicator for acute care hospitals. An innovative pressure ulcer prevention care bundle targeting patient participation in their care was recently tested in a cluster randomised trial in eight Australian hospitals. Our team developed a pressure ulcer prevention care bundle (PUPCB) targeted at both patients and nurses, encouraging patient participation in PUP care with three simple evidence-based messages: 1) Keep moving; 2) Look after your skin; and 3) Eat a healthy diet [12]. These messages were delivered to patients with a poster, brochure and DVD. Surgical and rehabilitation wards considered to have a high number of patients at risk of PU were included in the study
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