Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: a mixed methods evaluation

Barriers and facilitators of adherence to evidence-based pressure injury prevention clinical practice guideline among intensive care nurses: A cross-sectional survey

OBJECTIVE

To explore intensive care unit (ICU) nurses' perceptions of their adherence to pressure injury prevention clinical practice guideline and identify the perceived barriers and facilitators that influence evidence-based pressure injury prevention practices in Chinese tertiary hospitals.

RESEARCH METHODOLOGY/DESIGN

This was a multi-site, quantitative, cross-sectional study. Data were collected using a self-report questionnaire with three sections: participant demographic information, adherence to pressure injury prevention clinical practice guideline, and barriers to and facilitators of pressure injury prevention clinical practice guideline implementation.

SETTING

Thirty-three adult ICUs in 16 tertiary general hospitals in 5 major cities in Liaoning Province, China.

RESULTS

In total, 473 nurses responded to the survey. The mean score for adherence to pressure injury prevention clinical practice guideline was 159.06 ± 20.65, with 65.3 % reporting good adherence. Multiple stepwise regression analysis indicated that smaller ICU size (β = -0.114, p = 0.012) and having participated in training on pressure injury prevention clinical practice guideline (β = 0.149, p = 0.001) were statistically significantly associated with better adherence. ICU nurses identified the low priority given to pressure injury prevention as the top barrier. The top three facilitators were awareness of evidence-based practice, the current documentation format for pressure injury risk/nursing interventions, and leadership support.

CONCLUSION

ICU nurses' adherence to pressure injury prevention clinical practice guideline was satisfactory, and they reported low-to-moderate barriers and moderate facilitators.

IMPLICATIONS FOR CLINICAL PRACTICE

Participating in training on pressure injury prevention clinical practice guideline was a predictor of ICU nurses' adherence. Therefore, it is highly recommended that healthcare organisations consider providing training to nurses and address the barriers identified to improve nurses' adherence to evidence-based pressure injury prevention guidelines.

Investigation of related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy

OBJECTIVE

The aim of this study is to examine related factors of operating room nurses' attitudes and awareness towards surgery-related pressure injury prevention in Turkey, Croatia, and Italy.

METHODS

A descriptive and cross-sectional design was used. The study was conducted between March and September 2023. Data were collected with an online questionnaire created on Google Forms, consisting of a Nurse Information Form, a Surgery-related Pressure Injury Awareness Form, and the Attitude towards Pressure Ulcer Prevention Instrument.

RESULTS

The sample of the study consisted of 258 operating room nurses working in Turkey, Croatia, and Italy. It was found that the majority of the participants (70.90 %) did not use a risk scale, had not received education on pressure injury prevention and treatment (58.10 %) but wanted to receive it (86 %). Mean attitude scores of operating room nurses by country were at an adequate level in Turkey (42.48 ± 4.30) but not at the desired level in Croatia (37.48 ± 3.44) and Italy (36.20 ± 4.02). While there was a significant positive relationship between the awareness and attitudes of operating room nurses in Turkey (p = 0.002) and Croatia (p < 0.001), no relationship was found between these variables of nurses in Italy (p = 0.109). A statistically significant difference was found between nurses' consideration of themselves sufficient and their attitudes and awareness in all three countries (p < 0.05). It was also determined that reading articles affected nurses' awareness in all countries.

CONCLUSIONS

While operating room nurses' attitudes towards preventing pressure injuries were adequate in Turkey, it was determined that those of the nurses in Croatia and Italy were not at the desired level. Nurses should receive regular training on surgical pressure injuries to increase their awareness and to support them in implementing the recommendations of pressure injury guidelines in accordance with institutional policy.

Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis

AIM

This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI.

DESIGN

A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023.

METHODS

Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach.

RESULTS

Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence.

CONCLUSION

These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings.

IMPACT

Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.

The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal's Long-Term Care Units

BACKGROUND

The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people's quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care.

METHODS

A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders.

RESULTS

A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 "Floating so that staffing is equalised among units" is strongly associated with a shorter PU healing time.

CONCLUSION

A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.

Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review

OBJECTIVE

To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings.

METHODS

A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention.

RESULTS

A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences".

CONCLUSION

The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.

The knowledge and attitudes regarding pressure ulcer prevention among healthcare support workers in the UK: A cross-sectional study

BACKGROUND

Pressure ulcers cause significant, detrimental effects on personal wellbeing. They represent a serious health and social care burden. Nurses and those working in support roles are primarily accountable for preventing pressure ulcers. Healthcare support workers are an expanding group of key workers in the UK.

OBJECTIVE

To examine healthcare support workers' knowledge and attitudes regarding pressure ulcer prevention.

METHODS

A cross-sectional study was conducted from December 2020 to June 2021, using Knowledge and Attitudes toward Pressure Ulcer Prevention Assessment Tool.

RESULTS

A total of 164 participants completed the questionnaire fully. A low mean knowledge score of 0.42 ± 0.14, but a positive attitude score of 0.76 ± 0.10 per item were reported. The weakest areas of knowledge include aetiology, risk assessment and addressing pressure-reducing interventions for patients at risk. Higher mean scores per item in knowledge of pressure ulcer prevention were reported in participants working in acute hospital wards and nursing homes (0.468 ± 0.15, 0.47 ± 0.08 respectively) than those in other settings (p < 0.05). Participants working in primary care scored lowest (0.33 ± 0.12). The scores of participants with more positive attitudes towards pressure ulcer prevention significantly correlated with higher score of knowledge (p < 0.005).

CONCLUSION

While positive attitudes towards pressure ulcer prevention exist among healthcare support workers, this is overshadowed by significant knowledge deficits. Findings highlight the importance of continuing structured education for support workers across both acute and community settings. A future national survey and interventional study are needed to examine support workers' pressure ulcer knowledge and to inform a national continuous education strategy.

Formal Caregiver Experiences of Caring for Individuals at Risk for or with a Pressure Injury: A Metasynthesis

OBJECTIVE

To explore formal caregiver experiences caring for patients with a pressure injury (PI) or who are at risk of developing a PI.

DATA SOURCES

In November 2019, the researchers searched CINAHL (Cumulative Index to Nursing and Allied Health Literature) and MEDLINE databases for articles related to caregivers and their experiences with PI prevention and care.

STUDY SELECTION

Twenty-eight qualitative studies were included in this review.

DATA EXTRACTION

Literature was graded and critiqued with regard to design and research quality and then synthesized utilizing a narrative approach.

DATA SYNTHESIS

Four themes were found within the literature: knowledge and education, environment and resources, collaboration and role clarity, and risk assessment.

CONCLUSIONS

Across healthcare settings, formal caregivers noted the importance of effective PI knowledge and education. Recognizing both barriers and facilitators to PI prevention and management within the healthcare environment can help decision-makers make informed choices to improve PI management within their settings. In addition, developing interprofessional team skills and relationships, rather than practicing in silos, may have an impact on PI management. Although there are many interventions that reduce PI risk and assist in the management of PIs, not every intervention is appropriate for every healthcare setting. Clinician education on PIs, along with new interventions, could significantly impact the effectiveness of patient care.

Content Validity and Reliability of the Pressure Ulcer Knowledge Test and the Knowledge Level of Portuguese Nurses at Long-Term Care Units: A Cross-Sectional Survey

(1) Background: Improvement in pressure ulcer care depends both on the dissemination of knowledge and its implementation. This study aims to translate the Pressure Ulcer Knowledge Test into Portuguese from Portugal and evaluate the internal consistency of the questionnaire. The second aim is to assess nurses’ pressure ulcer knowledge level. (2) Methods: The Pressure Ulcer Knowledge Test was translated into Portuguese, and the translated test’s internal consistency and content validity were assessed. Further, the authors conducted a cross-sectional survey using the test among 221 nurses working in long-term care units. (3) Results: The Cronbach’s alpha internal coefficient of reliability recorded for the 47 items was 0.738, which is higher than the minimum acceptable level of 0.7. The Cronbach’s alpha for the subscales was 0.709 for prevention/risk and less than 0.5 for staging and wound description. Only two of the 221 nurses achieved a score of 90% correct answers or more. The nurses scored lower in questions related to prevention/risk (Me = 67.4%, IQR = 60.6–75.8% vs. staging: ME = 85.7%, IQR = 71.4–85.7%, description: ME = 85.7%, IQR = 71.4–85.7%, p < 0.001). (4) Conclusion: The internal consistency of the instrument was acceptable. The instrument can accurately measure Portuguese nurses’ knowledge of pressure ulcers, and its information can help improve education and implementation of best practices.

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.

Effects of Attitude, Barriers/Facilitators, and Visual Differentiation on Oral Mucosa Pressure Ulcer Prevention Performance Intention

Oral mucosa pressure ulcers (PUs) can result in frequent pain and discomfort, and have negative effects on quality of life. We aimed to examine attitude, barriers/facilitators of oral mucosa PU prevention, the ability to differentiate oral mucosa PU, and to identify factors influencing PU prevention performance intention. This was a cross-sectional descriptive study of 112 nurses in seven tertiary hospitals and three secondary hospitals. The data collection period was from August to December 2018. For data analysis, descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression were used. The mean score of attitudes toward oral mucosa PU prevention was 3.74 ± 0.39. Barriers to oral mucosa PU prevention were 5.65 ± 1.66, and facilitators were 5.35 ± 1.34. The mean correct answer rate of visual differentiation ability was 13%. The factors affecting intention to perform oral mucosa PU prevention were facilitators of oral mucosa PU prevention (β = 0.32, p = 0.001) and attitude (β = 0.26, p = 0.005). To increase intention to perform oral mucosa PU prevention, positive attitudes and enhanced facilitators should be encouraged. Therefore, standardized guidelines and strategies, such as educational opportunities and allocation of resources and personnel focused on oral mucosa PU prevention, need to be provided.

Factors related to knowledge, attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study

INTRODUCTION

As one of the main members of the health team, nurses have an important role in pressure ulcer prevention in health care centers. The aim of this study was to investigate knowledge, attitude, and practice of nurses on the prevention of pressure ulcers and their related factors.

METHODS

This cross-sectional study was carried out in 2018. The total number of ICU nurses employed in educational-health centers affiliated to Iran University of Medical Sciences were examined. Among a total of 328 nurses, 308 questionnaires were completed by the participants. Pressure Ulcer Knowledge Questionnaire, Attitude Toward Pressure Ulcer, and Practice of Pressure Ulcer Prevention questionnaires were used to collect data. SPSS software version 16 and independent t-test, Chi-square, Fisher exact, one-way Analysis of variance, and multiple linear regressions tests were used for data analysis.

FINDINGS

Based on the mean score of knowledge, attitude, and practice of the nurses about the pressure ulcer prevention were 63.47 ± 10.31, 39.10 ± 40.22, and 32.03 ± 6.17, respectively. There was a positive and significant relationship between these three variables. Findings revealed that knowledge was increased by 0.051 units, with a one-year increase in work experience of nurses in the ICU. Moreover, women's knowledge and their attitude were higher than those of men as 3.132 and 1.65 units, respectively. Based on the findings, attitude of nurses increased by 0.43 units for an hour of extra work per week. Nurses' attitude score in the General ICU and their practice were higher than scores of other nurses as 2.144 and 2.574 units, respectively. Moreover, practice of nurses increased by 0.162 unit with one-year increase of their age.

CONCLUSION

Given the undesirable level of knowledge and attitude and relatively desirable practice of nurses in the field of pressure ulcer prevention and the importance of improving the safety of patients admitted to the ICU, it is suggested that appropriate educational planning be developed to raise the level of knowledge, attitude, and practice of health care providers, especially nurses, in the area of pressure ulcer prevention.

Iranian nurses' knowledge, attitude and behaviour on skin care, prevention and management of pressure injury: A descriptive cross-sectional study

AIM

Pressure injuries as an indicator measuring the quality of nursing care and patient safety is a major health care problem worldwide. The aim of this study was to assess the knowledge, attitude and behaviour of nurses in preventing pressure injuries.

DESIGN

Descriptive cross-sectional study.

METHODS

This descriptive cross-sectional study enrolled 214 registered nurses in Iran. Patient satisfaction was assessed using pieker pressure ulcer knowledge test, attitude towards pressure ulcer tool and behaviour of pressure ulcer questionnaire. Data analysed by SPSSv.24 applying descriptive and inferential statistics.

RESULTS

The mean scores of knowledge, attitude and behaviour of nurses on the prevention of pressure injury were 27.24 (SD 5.23), 38.55 (SD 6.43) and 51.24 (SD 7.54), respectively. There was a correlation between knowledge, attitude and behaviour with the history of pressure injury training. Also, there was a significant relationship between knowledge with educational level and attitude with work experience. Knowledge, attitude and behaviour of nurses were in moderate level. Necessary measures to overcome problems such as the availability of pressure reducing equipments, motivating the nurses, eliminating the shortage of nurses and empowering nurses by holding practical workshops are important in providing patients safety.

An interprofessional approach to pressure ulcer prevention: a knowledge and attitudes evaluation

Background: Pressure ulcers (PUs) are a major burden to individuals, impacting their physical, mental and social wellbeing. While PU prevention is traditionally regarded as a nursing issue, an interprofessional approach has been promoted as best practice. However, little is known about current practice or the knowledge and attitudes of the wider interprofessional team (IPT). Purpose: Pre-designed questionnaires were used to explore knowledge and attitudes with healthcare staff in the community. Methods: Questionnaires were disseminated to all healthcare staff within a community healthcare Trust predominantly via an online tool. Data were analyzed using descriptive and inferential statistics. Results: The median values of all professional groups demonstrated satisfactory attitudes (>75%) and levels of knowledge (>60%) to PU prevention. However, there were differences within and between groups. Management staff demonstrated the most positive attitude to PU prevention (89%), followed by occupational therapists (OTs) and healthcare assistants (HCAs) (87%, IQR: 75%→89%). OTs demonstrated the highest scores for knowledge (69%, IQR: 62%→73%), while healthcare and rehabilitation assistants scored the lowest (58%, IQR: 58%-64%). Conclusion: This study has demonstrated that the majority of healthcare staff in a UK community setting have satisfactory levels of knowledge and attitudes in relation to PU prevention overall. Nevertheless, there were some differences between groups, albeit non-significant. There were also differences between sub-themes of the questionnaires, indicating a greater focus of pressure ulcer treatment over prevention. While PU prevention is widely regarded to be a nursing issue, these findings provide some indication of the potential for an interprofessional approach.

Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU)

AIM OF THE STUDY

The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers.

MATERIAL AND METHODS

An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016.

RESULTS

From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025-0.054).

CONCLUSIONS

The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers.

Attitudes of surgical nurses towards pressure ulcer prevention

STUDY AIM

Nurses play the key role in prevention of pressure ulcers, and negative attitudes of them may affect preventive care strategies. This research aimed to identify surgical nurses' attitudes towards pressure ulcer prevention.

MATERIALS AND METHODS

A descriptive and cross-sectional study design was used to collect data between March 31-May 16, 2016 on 101 voluntary nurses (66.01% of all nurses) working in surgical units of a university hospital in Turkey. "Attitude towards Pressure Ulcer Prevention Instrument" and "Nurse Information Form" were used to investigate nurses' attitude toward preventing pressure ulcer. Descriptive statistics, Mann-Whitney U test, independent samples t-test, Pearson's chi-squared, and correlation tests were used to analyse the data.

RESULTS

The mean age of nurses' was 32.0 ± 6.3 years and, the average duration of clinical experience was 72.3 ± 61 months. A total of 54.5% were working in surgical wards and, 40.6% gained additional education about pressure ulcer care. The mean total attitude score was found to be 80.5% (41.8 ± 4.8). Previous education significantly affected the total attitude score of nurses (p < 0.05).

CONCLUSION

The total scale score showed that surgical nurses had a positive attitude towards pressure ulcer prevention and nurses who had previous education about pressure ulcer care has higher attitude score than who had not. It is recommended that effective in-service education programs be developed at hospitals or that nurses be required to attend courses to help them to improve their pressure ulcer care.