title: Registered nurses' attention to and perceptions of pressure ulcer prevention in hospital settings.
abstract: OBJECTIVE
  To describe how registered nurses perform, document and reflect on pressure ulcer prevention in a specific nurse-patient care situation, as well as generally, on hospital wards.
  
  
  BACKGROUND
  Registered nurses should provide safe and qualified pressure ulcer prevention, but pressure ulcers remain a problem. Compliance with evidence-based guidelines impedes pressure ulcer formation.
  
  
  METHODS
  A descriptive design with a multimethods approach.
  
  
  METHODS
  Nine registered nurses at three wards and hospitals participated. The registered nurses were observed in a specific nurse-patient care situation with patients at risk for pressure ulcers. Interviews followed and patients' records were reviewed. Quantitative and qualitative data analysis methods were used.
  
  
  RESULTS
  Pressure ulcer prevention performed by the registered nurses was dependent on the cultural care, which ranged from planned to unplanned prevention. Diversity was found in compliance with evidence-based guidelines across the wards. Although all patients involved were at risk and the nurses described pressure ulcer prevention as basic care, the nurses' attention to prevention was lacking. Few prevention activities and no structured risk assessments using risk assessment tools were observed, and few care plans were identified. The lack of attention was explained by registered nurses' trust in assistant nurses' knowledge, and prevention was seen as an assistant nurse task.
  
  
  CONCLUSIONS
  Registered nurses paid little attention to pressure ulcer prevention among patients at risk. The planned and unplanned care structures affected the prevention. The nurses trusted and largely delegated their responsibility to the assistant nurses.
  
  
  CONCLUSIONS
  Evidence-based pressure ulcer prevention is fundamental to patient safety. Care quality is created in situations where patients and care providers meet. How registered nurses work with pressure ulcer prevention, their role and communication, particularly with assistant nurses, should be of major concern to them as well as to healthcare managers.
authors.affiliation: Clinical Training Centre, County Council of Gävleborg, Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden. eva.sving@lg.se
authors.forename: Eva
authors.initials: E
authors.lastname: Sving
authors.forename: Lena
authors.initials: L
authors.lastname: Gunningberg
authors.forename: Marieann
authors.initials: M
authors.lastname: Högman
authors.forename: Anna-Greta
authors.initials: AG
authors.lastname: Mamhidir
mesh_terms: D055318:Evidence-Based Nursing; D006801:Humans; D009741:Nursing Staff, Hospital / Q000523:psychology*; D003668:Pressure Ulcer / Q000517:prevention & control*