Aim: The aim of this study was to understand the perceptions of 11 Portuguese nurses' stakeholders regarding pressure ulcers prevention practice and reality in the hospital setting.
Methods: Convenience sampling was used to recruit nursing stakeholders for a heterogeneous focus group. A semi-structured interview was conducted with 11 nursing stakeholders involved in pressure ulcers prevention and/or patient safety. MaxQda 2020 qualitative analysis software was used in the content analysis and data processing. Informed consent was obtained, and anonymity was guaranteed.
Results: Four themes were approached in the interview: (1) Pressure ulcer risk assessment; (2) Nurses and doctors pressure ulcers monitoring; (3) Pressure ulcer risk profiles; and (4) Effective interventions to improve patient safety. The categorisation of the four themes was created aposteriori based on the 'Awareness/Knowledge/Competence, Opportunity, and Motivation - Behaviour Change Wheel' (adapted COM-B system). Interest, responsibility, autonomy, leadership and prioritisation for decision-making were some categories linked to motivation. Braden scale operationalisation, education given during undergraduate degree continued professional health education, missing care, reliability of the records and patients' clinical characteristics emerged as categories associated with awareness/knowledge/competence. Understaffing/nursing hours, health policies, electronic health records systems and clinical language used, access to appropriate equipment and resources, teamwork and clinical support specialist on tissue viability/wound care were some categories related to opportunity.
Conclusions: Pressure ulcer prevention is complex and requires a focussed attitude, robust evidenced-based knowledge and enhanced skills in risk assessment, communication and team collaboration. The highlighted categories could be further analysed at an organisational level to develop tailored strategies that could contribute to successful evidence-based practice implementation.
Relevance to clinical practice: The findings provide directions for behavioural change in the hospital context related to pressure ulcers prevention through awareness/knowledge/competence, motivation and opportunity to improve care delivered.
Keywords: computer-assisted qualitative data analysis; pressure injury; pressure ulcer; qualitative research; stakeholders.
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