Nurses' pressure ulcer related judgements and decisions in clinical practice: a systematic review.
BACKGROUND
Pressure ulcers are considered to be an adverse outcome of care that should never occur in clinical practice. The formation of a pressure ulcer is also perceived to be an indicator of poor quality nursing care. Therefore, pressure ulcer prevention is a priority for nurses, healthcare professionals and healthcare organisations throughout the world. A key factor in pressure ulcer prevention and management is individual nurse decision making.


OBJECTIVE
To synthesise the literature on the judgement and decision making of nurses in relation to the assessment, prevention, grading and management of pressure ulcers in all care settings (hospital and community).


METHODS
A systematic search of published literature relating to judgement and decision making in nurses, with a focus on the prevention and management of pressure ulcers.


METHODS
A search of electronic databases from 1992 to present, together with hand searching of the reference lists of retrieved publications, to identify published papers that reported results of studies evaluating the decision making of nurses in relation to the prevention and management of pressure ulcers. Abstracts were independently reviewed by two authors and full text of potentially relevant articles retrieved. Each paper included in this systematic review was evaluated using recognised appraisal criteria relevant to the specific study design. Included papers provided empirical data on key aspects of nurses' pressure ulcer related judgements and decision making. Data were synthesised into themes using narrative analysis.


RESULTS
Sixteen studies and one systematic review were included in the review, focusing on pressure ulcer risk assessment, pressure ulcer prevention, grading of pressure ulcers and treatment decisions. The results indicated that assessment tools were not routinely used to identify pressure ulcer risk, and that nurses rely on their own knowledge and experience rather than research evidence to decide what skin care to deliver.


CONCLUSIONS
Emphasising pressure ulcer risk assessment and pressure ulcer grading in clinical practice is unlikely to deliver improved outcomes. Further research into nurses' pressure ulcer related judgements and decision making is needed and clinicians must focus on the consistent delivery of high quality care to prevent and mange pressure ulcers to all patients in clinical practice.
Lecturer, School of Healthcare Science, Cardiff University, UK; Visiting Research Fellow, School of Healthcare, University of Leeds, UK. Electronic address: samuriwor@cf.ac.uk.
Ray
R
Samuriwo
Professor of Nursing, Columbia University School of Nursing, USA; Professor of Nursing, VNSNY (Visiting Nursing Service of New York); Center for Home Care Policy & Research.
Dawn
D
Dowding
D006801:Humans; D009740:Nursing Staff / Q000523:psychology*; D003668:Pressure Ulcer / Q000451:nursing*
Clinical practice; Decision making; Judgement; Nurses; Pressure ulcer; Systematic review