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Getting evidence-based pressure ulcer prevention into practice – looking into the ‘black-box’ of a multi-faceted intervention in a hospital setting
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
(English)Manuscript (preprint) (Other academic)
Keyword [en]
Pressure ulcer prevention, nursing care, implementation
National Category
URN: urn:nbn:se:uu:diva-234514OAI: oai:DiVA.org:uu-234514DiVA: diva2:756880
Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2015-02-03Bibliographically 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.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1042
Pressure ulcer prevention, nursing care, implementation, Trycksårsprevention, omvårdnad, implementering
National Category
Research subject
Caring Sciences in Social Sciences
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)
Available from: 2014-11-07 Created: 2014-10-13 Last updated: 2015-02-03

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