title: Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study.
abstract: BACKGROUND
  Implementation of evidence-based care for pressure ulcer prevention is lacking. As the hospital organization is complex, more knowledge is needed to understand how nursing care in this area can be improved.
  
  
  OBJECTIVE
  The present study investigated the associations between variables on different levels in the healthcare setting (patient, unit, hospital) and the documentation of (1) risk assessment and (2) skin assessment within 24h of admission, the use of (3) pressure-reducing mattresses and (4) planned repositioning in bed.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  One university hospital and one general hospital.
  
  
  METHODS
  Geriatric (n=8), medical (n=24) and surgical (n=19) units. All adult patients (>17 years), in total 825, were included.
  
  
  METHODS
  A one-day prevalence study was conducted using the methodology specified by the European Pressure Ulcer Advisory Panel, together with the established methods used by the Collaborative Alliance for Nursing Outcomes. Independent variables were patient characteristics, hospital type, unit type, nurse staffing and workload. Dependent variables were documented risk and skin assessment within 24h of admission, pressure-reducing mattresses and planned repositioning in bed. The data were analysed with Logistic regression using the Generalized Estimating Equation (GEE) approach.
  
  
  RESULTS
  Patients at risk of developing pressure ulcers (Braden<17) had higher odds of having risk assessment documented, and of receiving pressure-reducing mattresses and planned repositioning. Patients at the general hospital were less likely to have risk and skin assessment documented and to receive pressure-reducing mattresses. On the other hand, planned repositioning was more likely to be used at the general hospital. When total hours of nursing care was lower, patients had higher odds of having pressure-reducing mattresses but were less likely to have planned repositioning.
  
  
  CONCLUSIONS
  Patient characteristics (high age and risk score) and hospital type were associated with pressure ulcer prevention. Surprisingly, nurse staffing played only a minor role. Leaders in healthcare organizations should establish routines on different levels that support evidence-based pressure ulcer prevention, and registered nurses need to assume responsibility for bedside care.
authors.affiliation: Clinical Training Centre, County Council of Gävleborg, Sweden; Centre for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden. Electronic address: eva.sving@lg.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Sving
authors.affiliation: Department of Care Science, Faculty of Health and Society, Malmö University, Sweden; Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: Ewa
authors.initials: E
authors.lastname: Idvall
authors.affiliation: Centre for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; Department of Public Health Medicine, County Council of Gävleborg, Gävle, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Högberg
authors.affiliation: Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Sweden; School of Nursing, University of California, San Francisco, USA.
authors.forename: Lena
authors.initials: L
authors.lastname: Gunningberg
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055318:Evidence-Based Nursing; D006801:Humans
keywords: Associations; Hospital type; Nurse staffing; Patient characteristic; Pressure ulcer prevention; Unit type; Workload