Evidence-based Pressure Ulcer Prevention Research Articles

Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross-sectional study.

The aim of this correlational, cross‐sectional study was to assess the pressure ulcer prevention attitudes of the nursing staff and to identify factors associated with it both in primary and special health care. The study was conducted with nursing staff (N = 554) working in primary and special health care units in two hospital districts in Finlandin 2018 to 2019. Attitude towards Pressure ulcer Prevention instrument was used for data collection. Demographic data, Pressure Ulcer Prevention Knowledge test, and Pressure Ulcer Prevention Practice instrument were used as background variables. Data were analysed with statistical tests. Nursing staff working in primary care (n = 327) had more positive attitudes towards pressure ulcer prevention than those in specialised care (n = 209; P = .047). Working as a wound care nurse (P = .0005), working experience after graduation (P = .0017), self‐reported pressure ulcer prevention and early detection skills (P < .0001), pressure ulcer prevention knowledge (P = .0002), and views about the realisation of their unit's pressure ulcer prevention practices (P < .0001) independently explained variation in participants' attitudes. Attention should be placed on the pressure ulcer prevention attitudes of nurses who are less experienced or less skilled and who have lower pressure ulcer prevention knowledge. Positive organisational culture towards evidence‐based pressure ulcer prevention practices should be promoted.

Factors determining nurses' knowledge of evidence-based pressure ulcer prevention practices in Finland: a correlational cross-sectional study.

Pressure ulcers cause economic burden, human suffering, pain and decreased health-related quality of life in patients. Pressure ulcers are preventable in most cases, and nursing staff knowledge is a key factor in successful pressure ulcer prevention. Further evidence is needed to better tailor pressure ulcer prevention training programmes to the nursing staff. To evaluate the level of nursing staff knowledge about evidence-based pressure ulcer prevention practices in both primary and specialised care, and to identify what factors determine nurses' knowledge levels. A correlational, cross-sectional study was conducted from 2018 to 2019 in two hospital districts in Finland. The Pressure Ulcer Prevention Knowledge test was used to collect data, and the Attitude towards Pressure ulcer Prevention (APuP) instrument was used as a background variable. The data were statistically analysed with Wilcoxon and Kruskal-Wallis tests, Spearman correlations and multiple linear regression. The pressure ulcer prevention knowledge of the participating registered nurses, practical nurses and ward managers (N=554) was on average 24.40 (max. 35.00). There was no difference in the participants' knowledge based on the type of unit in which they were working (primary or specialised care). The participants' attitudes (p<0.0001), current position (p=0.0042), frequency of taking care of patients with pressure ulcers (p=0.0001) and self-evaluated training needs (p<0.0001) independently explained the variation in the knowledge scores. Special attention needs to be paid to the knowledge of those nurses working in positions that require lower levels of education and those who rarely take care of patients with pressure ulcers. Supporting nurses' positive attitudes towards pressure ulcer prevention should be an essential part of pressure ulcer prevention training. Nurses' self-evaluations of their training needs can be used to target training. The limitations of the study should be considered when generalising the results.

Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: A qualitative study informed by the theoretical domains framework.

Pressure ulcer reduction is a healthcare priority. Good clinical guidelines have the potential to transform pressure ulcer prevention and management practices. However, evidence suggests these guidelines are inconsistently utilised. The aim of this study was to explore health practitioners' perceived barriers and enablers to the implementation of evidence-based pressure ulcer prevention and management recommendations in an integrated community care setting. The study used a qualitative exploratory design. It took place in a community Trust in London, England. Semi-structured interviews were conducted with a purposive sample of registered nurses and allied healthcare professionals (AHPs). The Theoretical Domains Framework (TDF) informed both data collection and data analysis. Analysis followed a five-step process including deductive coding of the transcripts and inductive generation of specific belief statements. Nine nurses and four AHPs took part in the study. Six TDF domains were identified as most relevant to the implementation of best practice in pressure ulcer prevention and management: Goals, Knowledge, Skills, Beliefs about capabilities, Environmental context and resources and Social influences. All participants felt it was important to prevent pressure ulcers and were motivated to do so. Key enablers to the implementation of evidence-based practice included high levels of self-reported pressure ulcer knowledge and skills (nurses), responsive community equipment provision, the introduction of novel Pressure Ulcer Implementation Facilitator roles and integrated team working. Barriers included self-reported deficits in knowledge and skills (AHPs), worries about inspecting intimate anatomical locations (AHPs), difficulties initiating conversations with patients about risk and behaviour change, high workloads and clutter in the home. Family members and mobile working solutions were identified as both enablers and barriers. Potential routes to addressing implementation challenges are identified and recommendations made for future research.

A multifaceted intervention for evidence-based pressure ulcer prevention: a 3 year follow-up.

To assess sustainability of an intervention used to implement pressure ulcer prevention. The Promoting Action on Research Implementation in Health Service, framework was used to develop an intervention aimed to implement evidence-based pressure ulcer prevention in a hospital setting. A short-term follow-up showed that significantly more patients received pressure ulcer prevention. A qualitative process evaluation gave support that the intervention and the implementation process changed the understanding and approach to working with pressure ulcer prevention from treating to preventing. The study had a sequential mixed method approach, combining quantitative and qualitative data. For the quantitative data, baseline and short-term follow-up (6-8 months) data reported in an initial study were compared with long-term follow-up (36-42 months) data (n = 259 patients). For the qualitative data, interviews with registered nurses (n = 20), assistant nurses (n = 7) and first-line managers (n = 5) were performed. The performance of pressure ulcer prevention was sustained 3 years from its conception. The number of patients with pressure ulcers was reduced (P = 0.021). Systematic work with quality measurements, support from first-line managers, internal facilitation, collaboration and pressure ulcer prevention skills could explained the sustainability. Obstacles to achieve high-quality pressure ulcer prevention were inadequate communication, high workloads and high rates of new and substitute nurses. Three different components for sustainability on the micro-level are described; benefits for the patients, the need for routinization and development over time. Threats to sustainability are described as factors on the macro-level. There needs to be collaboration in the healthcare organization from the micro-to-macro levels, and committed experienced nurses are needed to obtain high-quality sustainable pressure ulcer prevention.

Performance of Evidence-based Pressure Ulcer Prevention Practices among Hospital Nurses

Performance of Evidence-based Pressure Ulcer Prevention Practices among Hospital Nurses

Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.

In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled "Healthy Skin Wins" with an online tutorial about PU prevention. To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff's knowledge level about PU prevention, and to explore frontline staff's perspectives of the PUPP. This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff's knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff's perspectives of the PUPP. A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p < .001). The online tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirty-five frontline staff shared their perspectives of the PUPP with "it's definitely a combination of everything" and "there's a disconnect between what's needed and what's available" as the main themes. Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare aides, patients and families.

Barriers to evidence-based pressure ulcer prevention in Intensive Care Units

Aim of the study: The aim of the present study was to determine the barriers to evidence-based pressure ulcer prevention in Intensive Care Units. Research design and setting: A descriptive crosssectional design was selected to conduct the current study in the ICU units of Zagazig University Hospitals.Subjects: 200 nurses from the above mentioned setting who met the inclusion criteria. Tools of data collection: A Self-administered questionnaire was used. Results: Most of the nurses in the study sample (80%) were having unsatisfactory total knowledge about pressure ulcers. Majority of the nurses in the study sample (90.5%) were having positive attitudes towards the prevention of pressure ulcers. slightly more than two-thirds of them (69.0%) were having high perception of barriers hindering the application of EBP in pressure ulcers prevention. It is noticed that the highest perceived barriers were related to the work environment (62%), whereas the lowest were related to nursing (11.5%). Conclusion: The main barriers to implementation of evidence-based preventive practices for pressure ulcers revealed in the study are the nurses’ deficient knowledge, in addition to the work environment-related barriers. Recommendations: Training programs for nurses about evidence-based pressure ulcer prevention, improvement of work environment and further study for their effectiveness are recommended.

Study protocol of a cluster randomized controlled trial evaluating the efficacy of a comprehensive pressure ulcer prevention programme for private for-profit nursing homes.

BackgroundBecause the demand for government-subsidized nursing homes in Hong Kong outstrips the supply, the number of for-profit private nursing homes has been increasing rapidly. However, the standard of care in such homes is always criticized. Pressure ulcers are a major long-term care issue that is closely associated with the quality of care delivered in nursing home settings. The aim of this study is to evaluate the effectiveness of a pressure ulcer prevention programme for residents in private for-profit nursing homes.Methods/designThis is a two-arm cluster randomized controlled trial with an estimated sample size of 1088 residents and 74 care staff from eight for-profit private nursing homes. Eligible nursing homes will be those classified as category A2 homes in the Enhanced Bought Place Scheme (EBPS), having a capacity of around 130–150 beds, and no structured PU prevention protocol and/or programmes in place. Care staff will be health workers, personal care workers, and nurses who are front-line staff providing direct care to residents. Eight nursing homes will be randomly assigned to either an experimental or control group. The experimental group will be provided with an intensive training programme and will be involved in the implementation of a 16-week pressure ulcer prevention protocol, while the control group will deliver the usual pressure ulcer prevention care. The study outcomes are the pressure ulcer prevention knowledge and skills of the care staff and the prevalence and incidence of pressure ulcers. Data on the knowledge and skills of care staff, and prevalence of pressure ulcer will be collected at the base line, and then at the 8th week and at completion of the implementation of the protocol. The assessment of the incidence of pressures will start from before the commencement of the intensive training course to the end of the implementation of the protocol.DiscussionIn view of the negative impact of pressure ulcers, it is important to have an effective and evidence-based pressure ulcer prevention programme to improve preventive care in private for-profit nursing homes. The programme will potentially improve the knowledge and skills of care staff on the prevention of pressure ulcers and also lead to a reduction in the development of pressure ulcers in nursing homes.Trial registrationThe Current Controlled Trial is NCT02270385, 18 October 2014.

Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting.

The aim of the study was to evaluate whether a multi-faceted, unit-tailored intervention using evidenced-based pressure ulcer prevention affects (i) the performance of pressure ulcer prevention, (ii) the prevalence of pressure ulcers and (iii) knowledge and attitudes concerning pressure ulcer prevention among registered and assistant nurses. A quasi-experimental, clustered pre- and post-test design was used. Five units at a hospital setting were included. The intervention was based on the PARIHS framework and included a multi-professional team, training and repeated quality measurements. An established methodology was used to evaluate the prevalence and prevention of pressure ulcers. Nurses' knowledge and attitudes were evaluated using a validated questionnaire. A total of 506 patients were included, of whom 105 patients had a risk to develop pressure ulcer. More patients were provided pressure ulcer prevention care (P = 0·001) and more prevention care was given to each patient (P = 0·021) after the intervention. Corresponding results were shown in the group of patients assessed as being at risk for developing pressure ulcers. Nurses' knowledge about pressure ulcer prevention increased (P < 0·001). Positive attitudes towards pressure ulcer prevention remained high between pre- and post-test surveys. This multi-faceted unit-tailored intervention affected pressure ulcer prevention. Facilitation and repeated quality measurement together with constructed feedback of results seemed to be the most important factor for pressure ulcer prevention.

Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study

BackgroundImplementation of evidence-based care for pressure ulcer prevention is lacking. As the hospital organization is complex, more knowledge is needed to understand how nursing care in this area can be improved. ObjectivesThe present study investigated the associations between variables on different levels in the healthcare setting (patient, unit, hospital) and the documentation of (1) risk assessment and (2) skin assessment within 24h of admission, the use of (3) pressure-reducing mattresses and (4) planned repositioning in bed. DesignA cross-sectional study. SettingsOne university hospital and one general hospital. ParticipantsGeriatric (n=8), medical (n=24) and surgical (n=19) units. All adult patients (>17 years), in total 825, were included. MethodsA one-day prevalence study was conducted using the methodology specified by the European Pressure Ulcer Advisory Panel, together with the established methods used by the Collaborative Alliance for Nursing Outcomes. Independent variables were patient characteristics, hospital type, unit type, nurse staffing and workload. Dependent variables were documented risk and skin assessment within 24h of admission, pressure-reducing mattresses and planned repositioning in bed. The data were analysed with Logistic regression using the Generalized Estimating Equation (GEE) approach. ResultsPatients at risk of developing pressure ulcers (Braden<17) had higher odds of having risk assessment documented, and of receiving pressure-reducing mattresses and planned repositioning. Patients at the general hospital were less likely to have risk and skin assessment documented and to receive pressure-reducing mattresses. On the other hand, planned repositioning was more likely to be used at the general hospital. When total hours of nursing care was lower, patients had higher odds of having pressure-reducing mattresses but were less likely to have planned repositioning. ConclusionPatient characteristics (high age and risk score) and hospital type were associated with pressure ulcer prevention. Surprisingly, nurse staffing played only a minor role. Leaders in healthcare organizations should establish routines on different levels that support evidence-based pressure ulcer prevention, and registered nurses need to assume responsibility for bedside care.

Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care

One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). A cross-sectional retrospective review of health records. Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper-based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0.001), size (p = 0.004), risk assessment (p = 0.002), nursing history (p = 0.040), nursing diagnoses (p < 0.001), nursing goals (p < 0.001) and nursing outcomes (p = 0.016) in 2006 than in 2002. One third of the recordings used preformulated templates. Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow-up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. Education related to the use of the electronic health record and evidence-based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user-friendly.

Professional Practice-Implementing a Pressure Ulcer Prevention Program

OBJECTIVE: To decrease the overall rate of hospital-acquired pressure ulcers in hospital through education on risk assessment prevention protocols, and collaboration of skin team members, WOCN and nursing staff. DESIGN: Tracking of retrospective documentation of monthly hospital-acquired pressure ulcer rates for the past four fiscal years. SETTING: A 238-bed rural tertiary Level II Trauma Center in Northeastern Penna. PARTICIPANTS: Patients with hospital-acquired pressure ulcers from July 1, 2004–June 30, 2008. INTERVENTIONS: Mentoring and mandatory education of nurses and care partners by skin Team members and WOCN regarding identification of at-risk patients and implementation of prevention measures. Skin care team members attended quarterly team meetings, participated in quarterly prevalence studies, and participated in chart reviews and education. Evidence-based pressure ulcer prevention protocols and treatment protocols were implemented. This allowed nurses to enter the prevention or treatment of pressure ulcers. In January of 2006 a qualitative initiative called “Measurement Monday” was implemented to improve documentation of impaired skin with a designated day of the week for measurements. In January of 2007 a uniform documentation tool for impaired skin was implemented on the nursing units. In March of 2008 computerized epic documentation for electronic record was implemented. Pressure ulcer rates also became part of the nursing managers' report card and yearly goals. Discussion of pressure ulcer rates and measures to decrease rates were ongoing. Our Vice President of Nursing and Chief Nursing Officer provided ongoing support for our prevention strategies and programs. RESULTS: Incidence of hospital-acquired pressure ulcers decreased yearly over the 4 years with an overall decrease of 46% from 2004–2008. CONCLUSION: Reduction in incidence of hospital-acquired pressure ulcers was achieved through pressure ulcer prevention measures, education and the collaborative approach of skin team members, WOCN, nurses, care partners, management and administration (Russo).

Creation and Implementation of a Pressure Ulcer Prevention Bundle Improves Patient Outcomes

Increased pressure ulcer prevalence and incidence rates led to the development of a pressure ulcer prevention program. To decrease pressure ulcer rates below national levels by implementing strategies to improve patient outcomes. Patients admitted to the Stony Brook University Medical Center (SBUMC) are assessed for placement in the pressure ulcer prevention program. The central element of the program is an evidence-based Pressure Ulcer Prevention Bundle using the "Bundle" concept from the Institute for Healthcare Improvement. The March 2006 Prevalence and Incidence Benchmarking Study demonstrates not only a decrease in institutional prevalence and incidence rates but also places SBUMC rates below last year's national benchmark rates. The implementation of a pressure ulcer prevention program has decreased prevalence and incidence rates at SBUMC and improved the quality of patient care.

Pressure ulcer prevention and treatment practices in inpatient rehabilitation facilities.

Although many strategies have been developed to prevent pressure ulcers, they remain a significant healthcare problem, particularly for chronically ill patients in rehabilitation facilities. This study describes self-reported pressure ulcer prevention and treatment practices in rehabilitation facilities. Surveys were sent to all 52 licensed inpatient rehabilitation facilities in Missouri; the response rate was 76.9%. Less than 30% of the facilities used inexpensive nursing interventions such as keeping the head of a patient's bed at or below a level of 30 degrees. Informally established protocols were used more frequently than the evidence-based pressure ulcer prevention and treatment guidelines issued by the Agency for Health Care Policy and Research. Furthermore, only 50% of the respondent facilities used established, valid, and reliable risk assessment tools. There was little difference in the interventions used when a client either developed a pressure ulcer or was assessed as being at risk for an ulcer. These findings reveal a significant gap between research and practice and suggest a need to educate rehabilitation nurses about the most appropriate, evidence-based nursing interventions for preventing and treating pressure ulcers.

Pressure Ulcer Prevention and Treatment: A Synopsis of the Current Evidence from Research

Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure ulcers in people at risk. The relative merits of AP and CLP devices and of the different AP devices for pressure ulcer prevention are unclear. There is some evidence from one study to suggest that LAL beds may reduce the incidence of pressure ulcers compared with standard intensive care beds. There is insufficient evidence to make conclusions on the value of various CLP devices and sheepskins as pressure ulcer prevention strategies, although Australian Medical Sheepskin was an effective preventive strategy in a recent study. There is evidence from two trials that air-fluidized therapy may improve pressure ulcer healing rates. There is insufficient evidence to make conclusions on the value of other beds and mattresses as pressure ulcer treatments. There is insufficient evidence to recommend any particular wound dressing or debridement technique. Research about pressure ulcer prevention and treatment is generally conducted on a small scale and is of poor quality; few economic evaluations have been undertaken of pressure area care strategies. Only when a clinically relevant research agenda has been developed and appropriate research methods have been used in sufficiently large studies can evidence-based pressure ulcer prevention and treatment be a possibility. Until then, nurses and other health care professionals can only rely on what little research evidence exists together with their professional judgment to make decisions in this field.