title: Pressure ulcer guideline development and dissemination in Europe.
abstract: OBJECTIVE
  To explore the current state of pressure ulcer guideline development and dissemination, from national to local level (i.e. nursing homes) in six European countries: England, Germany, Italy, the Netherlands, Portugal and Sweden.
  
  
  BACKGROUND
  Pressure ulcers are a persistent problem in healthcare institutions. Their prevalence is influenced by many factors, one of them being the development and dissemination of pressure ulcer guidelines. These are difficult and complex processes and it is not clear whether they differ between European countries.
  
  
  METHODS
  Literature review and semi-structured interviews.
  
  
  METHODS
  Interviews were conducted in six countries at national and nursing home level.
  
  
  RESULTS
  Four countries had national pressure ulcer prevention and treatment guidelines. Portugal had no national guidelines and Sweden had shifted the responsibility to regional level. All participating nursing homes had pressure ulcer guidelines except those in Portugal. Control and monitoring of guideline dissemination was carried out only in Sweden and England.
  
  
  CONCLUSIONS
  All countries studied have national or regional pressure ulcer prevention and treatment guidelines, except Portugal. Portugal is also the only country where none of the nursing homes included had pressure ulcer guidelines. Because the dissemination of such guidelines does not imply actual implementation, further research should focus on the implementation process.
  
  
  CONCLUSIONS
  Clinical guidelines, like pressure ulcer guidelines, are important tools in guiding the care processes in healthcare institutions. Successful dissemination of guidelines from national level to individual healthcare institutions is a first and necessary step in actually applying them. Monitoring of the guideline dissemination process is therefore essential.
authors.affiliation: Department of Health Care and Nursing Science, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands. e.meesterberends@zw.unimaas.nl
authors.forename: Esther
authors.initials: E
authors.lastname: Meesterberends
authors.forename: Ruud
authors.initials: R
authors.lastname: Halfens
authors.forename: Christa
authors.initials: C
authors.lastname: Lohrmann
authors.forename: Rianne
authors.initials: R
authors.lastname: de Wit
mesh_terms: D004059:Diffusion of Innovation; D005060:Europe; D017408:Guidelines as Topic; D006801:Humans; D003668:Pressure Ulcer / Q000451:nursing*