An interdisciplinary approach to pressure ulcer prevention in the community setting: exploring the barriers and facilitators for implementation.

Abstract

Pressure ulcers (PUs) are a burden to individuals’ physical, mental and social wellbeing (Spilsbury et al. 2007), with a financial impact for individuals, healthcare organisations and society (Gorecki et al. 2009; Demarré et al. 2015b). A team-based approach towards their prevention has long been promoted as best practice, yet little is known about its application or efficacy in practice (Gottrup et al. 2001; Cramp et al. 2004; Bergquist-Beringer and Makosky Daley 2011; NICE 2014).

The aim of the thesis was to explore the knowledge, attitudes and perceptions of healthcare staff in order to understand barriers and facilitators to interdisciplinary PU prevention. A sequential mixed methods design was adopted to achieve this aim, with questionnaires, focus groups and interviews conducted with health care staff from a community NHS Trust. The results of these questionnaires were used to inform focus groups and interview discussions with nurses/healthcare assistants (HCAs), allied health professionals (AHPs), non-caseholding clinicians and tissue viability nurses (TVNs). These data were coded and matched to determinants of behavioural change using two taxonomies, which subsequently established a series of techniques for use within an interdisciplinary intervention (Abraham and Michie 2008; de Bruin et al. 2009; EPOC 2015).

The integrated quantitative and qualitative results established the following determinants of behaviour change: knowledge, attitude, awareness, social influence, organisational factors and structural factors. Participants demonstrated a high level of knowledge in relation to ‘aetiology and development’, but poor knowledge of ‘preventive measures’, with nurses and AHPs displaying the same levels of knowledge overall. However, nurses were found to have a more positive attitude and a greater personal competency to PU prevention that the pooled data for AHPs. Nevertheless, when divided by profession occupational therapists and HCAs reported a more positive attitude than nurses. While participants demonstrated strong awareness of the impact of PUs, there was a limited understanding of the role that different professional groups could play in prevention. Furthermore, there was some variability in the responses from a variety of professions over whether PUs were preventable in high risk groups. Consequently, it was reported that in some areas the focus of practice had changed from prevention to ensuring that if a PU did occur it would be classified as unavoidable. Organisational and structural barriers to achieving prevention included insufficient time and staffing; while for team-based practice, participants described the impact on communication of nursing and AHP teams working from different locations. The importance of effective leadership and education were identified as facilitators to achieving an interdisciplinary approach to PU prevention.

An interdisciplinary training programme was developed and feasibility tested with one community team based on the previous results and a framework of the characteristics of a good interdisciplinary team (Nancarrow et al. 2013). The content and format of the programme was considered acceptable, however the tools used to measure the programme’s effectiveness lacked sensitivity to detect a meaningful difference. The programme focused on the individual and team-based determinants of practice, however, achieving an interdisciplinary approach to PU prevention requires the integration of other practice determinants. These include process, organisational and contextual factors (Reeves et al. 2010).

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Identifiers

ORCID for Paul Clarkson: orcid.org/0000-0001-5955-5711

ORCID for Peter Worsley: orcid.org/0000-0003-0145-5042

ORCID for Daniel Bader: orcid.org/0000-0002-1208-3507

ORCID for Lisette Schoonhoven: orcid.org/0000-0002-7129-3766

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