Preventing pressure ulcers in nursing homes using a care bundle

Abstract

Background: Pressure ulcers are localised injuries to the skin, underlying tissue, and bone; and can cause pain, impacting health-related quality of life. Care bundles incorporate 3-5 nursing practices, and are used to improve adherence to evidence-based guidelines. This project aims to design, implement, and assess a pressure ulcer prevention care bundle in nursing homes. Methods: A mixed methods design involving a systematic review, semi-structured interviews, a priority-setting workshop, and a feasibility study. Nursing home and community-based nurses involved in the care of people at risk of developing pressure ulcers will be purposively recruited to face-to-face interviews exploring the barriers and facilitators of evidence-based practice. Using the Theoretical Domains Framework, a deductive thematic analysis will ensue. Qualitative data will be triangulated with systematic review findings, NICE guidelines, and proceedings from a priority-setting workshop. This will culminate in a feasibility study in three nursing homes. Expected results: Identifying the theoretical domains associated with best practice, and appropriate behaviour change strategies, behaviour change among care staff will be facilitated. Fewer pressure ulcers are expected to develop as they will be identified earlier, and monitored and documented more effectively. Current stage of work: The project has been designed, and ethics approvals granted. Face-to-face interviews are complete; and the systematic review data are being extracted. Discussion: Care bundles, and the implementation processes, appear to have limited reference to theory. Thus, it is important to demonstrate how health psychology theory can be used across disciplines to facilitate the uptake of evidence-based nursing practices.