Abstract
Background: Pressure ulcers (PU) can be painful and negatively affect health‐related quality of life and healthcare costs. This study aims to explore implementation strategies to promote knowledge transfer, capacity building, and evidence-based practice, and their interaction within the context of long-term care units.
Approach: This study aimed to explore implementation strategies to promote knowledge transfer, capacity building, and evidence-based practice, and their interaction within the context of long-term care units. The Medical Research Council framework was used for development and implementation phases. Firstly, three quantitative studies were performed to identify barriers and facilitators in structure and process and results associated with prevention and treatment of patients with PU: (1) To assess knowledge, Pressure Sore Status Tool was used; (2) Quality of care was evaluated using the Pressure Sore Score Tool and wounds documentation in the electronic platform; (3) Nursing work environment was evaluated through Nursing Work Environment Revised tool. Secondly, an intervention that included education on prevention of PU, nursing leadership in wound care, sustained engagement with focus group and dynamic intervention design was implemented as a pilot study, in three units (58 patients).
Results: The sample comprised wounds from all patients admitted between June 2023 and March 2024. During this period, a total of 1145 wounds were observed in 447 patients. From these wounds, 1005 (87.8%) were pressure ulcers. The subsample in the units where interventions were carried out consisted of a total of 77 wounds (67 pressure ulcers). In these units 96.2% of cases had adequate nutrition, compared with 76.1% without intervention. In the three units 100% of the cases were hydrated, compared with 84.0% without intervention. 63.2% of cases had protein supplements, while in the units without intervention, this percentage was 53.2%. In the units where intervention took place, 98.2% of cases had patient-based positioning, while without intervention, this percentage was 88.9%.
Implications: Despite the limitations inherent to the significant size difference between the two subsamples, the intervention group performed better in most of the items evaluated. Involving nurses in Institution projects and top decisions are strategies that improve the quality of wound care. Next steps include a study of cost effectiveness of the intervention. PU are a priority in all Security National programs and this intervention was supervised by the Executive Committee of National Health Service, in Portugal.