East London NHS Foundation Trust, London, UK.
Centre for Health Services Research, School of Health Sciences, City, University of London, and East London NHS Foundation Trust, London, UK.
Health Soc Care Community. 2021 May;29(3):766-779. doi: 10.1111/hsc.13322. Epub 2021 Mar 4.
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.
压疮减少是医疗保健的重点。良好的临床指南有可能改变压疮预防和管理实践。然而，有证据表明这些指南的使用不一致。本研究旨在探讨在综合社区护理环境中，卫生保健从业者在实施基于证据的压疮预防和管理建议方面的感知障碍和促进因素。该研究采用定性探索性设计。它在英国伦敦的一家社区信托机构进行。对注册护士和专职医疗保健专业人员（AHPs）进行了有针对性的半结构化访谈。理论领域框架（TDF）同时指导数据收集和数据分析。分析遵循五个步骤，包括对转录本的演绎编码和特定信念陈述的归纳生成。九名护士和四名 AHPs 参与了这项研究。确定了六个 TDF 领域与最佳实践在压疮预防和管理中的实施最相关：目标、知识、技能、能力信念、环境背景和资源以及社会影响。所有参与者都认为预防压疮很重要，并对此有动力。实施循证实践的主要促进因素包括高水平的自我报告压疮知识和技能（护士）、响应性社区设备供应、引入新型压疮实施促进者角色以及整合的团队合作。障碍包括自我报告的知识和技能不足（AHPs）、担心检查亲密的解剖部位（AHPs）、难以与患者就风险和行为改变进行对话、工作量大以及家庭中的混乱。家庭成员和移动工作解决方案被确定为促进因素和障碍。确定了潜在的解决实施挑战的途径，并为未来的研究提出了建议。
