uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Registered nurses' attention to and perceptions of pressure ulcer prevention in hospital settings
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 9-10, 1293-1303 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To describe how registered nurses perform, document and reflect on pressure ulcer prevention in a specific nurse-patient care situation, as well as generally, on hospital wards.

Background: Registered nurses should provide safe and qualified pressure ulcer prevention, but pressure ulcers remain a problem. Compliance with evidence-based guidelines impedes pressure ulcer formation.

Design: A descriptive design with a multimethods approach.

Method: Nine registered nurses at three wards and hospitals participated. The registered nurses were observed in a specific nurse-patient care situation with patients at risk for pressure ulcers. Interviews followed and patients' records were reviewed. Quantitative and qualitative data analysis methods were used.

Results: Pressure ulcer prevention performed by the registered nurses was dependent on the cultural care, which ranged from planned to unplanned prevention. Diversity was found in compliance with evidence-based guidelines across the wards. Although all patients involved were at risk and the nurses described pressure ulcer prevention as basic care, the nurses' attention to prevention was lacking. Few prevention activities and no structured risk assessments using risk assessment tools were observed, and few care plans were identified. The lack of attention was explained by registered nurses' trust in assistant nurses' knowledge, and prevention was seen as an assistant nurse task.

 Conclusion: Registered nurses paid little attention to pressure ulcer prevention among patients at risk. The planned and unplanned care structures affected the prevention. The nurses trusted and largely delegated their responsibility to the assistant nurses.

Relevance to clinical practice: Evidence-based pressure ulcer prevention is fundamental to patient safety. Care quality is created in situations where patients and care providers meet. How registered nurses work with pressure ulcer prevention, their role and communication, particularly with assistant nurses, should be of major concern to them as well as to healthcare managers.

Place, publisher, year, edition, pages
2012. Vol. 21, no 9-10, 1293-1303 p.
Keyword [en]
caring culture, interviews, nursing care, observations, pressure ulcer prevention, records review
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-171937DOI: 10.1111/j.1365-2702.2011.04000.xISI: 000302721700011PubMedID: 22429848OAI: oai:DiVA.org:uu-171937DiVA: diva2:512937
Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Pressure Ulcer Prevention: Performance and Implementation in Hospital Settings
Open this publication in new window or tab >>Pressure Ulcer Prevention: Performance and Implementation in Hospital Settings
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Pressure ulcers are related to reduced quality of life for patients and high costs for health care. Guidelines for pressure ulcer prevention have been available for many years but the problem remains. Aim: The overall aim of this thesis was to investigate hospital setting factors that are important to the performance of pressure ulcer prevention and to evaluate an intervention focused on implementing evidence-based pressure ulcer prevention. Methods: Four studies with a qualitative and quantitative approach were conducted.  Registered nurses’ performance of pressure ulcer prevention for patients at risk was investigated. Factors related to pressure ulcer prevention at different levels in hospital organizations were examined (hospital and ward type, workload, and nurse staffing) in two hospitals. A quasi-experimental study evaluated the effects of an intervention focusing on pressure ulcer prevention and a descriptive study with interviews examined nurses and first-line managers’ experiences of this intervention. Results: All of the studies show that quality improvement was needed for patients at risk of pressure ulcer. Registered nurses attention to pressure ulcer prevention was low and the caring culture of the wards ranged from organized work to unorganized work. Factors related to pressure ulcer prevention were patients’ age (risk and skin assessment) and patients’ risk (skin assessment, pressure reducing mattresses and planned repositioning), type of hospital (university and general), and ward (geriatric, medical, and surgical). Nurse staffing and workload played a minor role. Significantly more patients received pressure ulcer prevention after the intervention. Important factors for improvement were the support nurses and managers received by external and internal facilitators. Another important factor was interpersonal communication on the care provided by the nurses and first-line managers. Conclusion: Quality improvement regarding evidence-based pressure ulcer prevention was needed. Factors associated with pressure ulcer prevention were related to all levels in the hospital settings. A comprehensive intervention showed statistically significant improvement in the care. Interpersonal communication among the staff based on quality measurements was the key factor. Managers from the micro- to the macro-level have to know the conditions for pressure ulcer prevention and, given their position, ensure that the necessary prerequisites are in place.

  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1042
Keyword
Pressure ulcer prevention, nursing care, implementation, Trycksårsprevention, omvårdnad, implementering
National Category
Nursing
Research subject
Caring Sciences in Social Sciences
Identifiers
urn:nbn:se:uu:diva-234028 (URN)978-91-554-9073-7 (ISBN)
Public defence
2014-11-28, Brömssalen, Gävle sjukhus, ingång 11, Centrum för Forskning och Utveckling, Uppsala Univsersitet/Landstinget Gävleborg. Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-11-07 Created: 2014-10-13 Last updated: 2015-02-03

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Sving, EvaGunningberg, LenaHögman, MarieannMamhidir, Anna-Greta

Search in DiVA

By author/editor
Sving, EvaGunningberg, LenaHögman, MarieannMamhidir, Anna-Greta
By organisation
Centre for Research and Development, GävleborgCaring SciencesRespiratory Medicine and Allergology
In the same journal
Journal of Clinical Nursing
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 1719 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf