title: Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting.
abstract: OBJECTIVE
  To describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multifaceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention.
  
  
  BACKGROUND
  Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes.
  
  
  METHODS
  A descriptive qualitative approach.
  
  
  METHODS
  Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used.
  
  
  RESULTS
  The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements.
  
  
  CONCLUSIONS
  The multifaceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feedback discussions among the staff regarding the results of the care provided also appear to be vital.
  
  
  CONCLUSIONS
  It is crucial that dedicated facilitators are involved to promote the implementation process. A preventative mindset should be strived for. Creating an implementation plan with an outcome and a process evaluation should be emphasised. It is important to give the staff regular feedback on the quality of care and on those occasions allocate time for discussion and reflection.
authors.affiliation: Department of Patient Safety, Region Gävleborg, Sweden.|Centre for Research & Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.|Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Sving
authors.affiliation: Centre for Research & Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Fredriksson
authors.affiliation: Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Gunningberg
authors.affiliation: Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.|Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
authors.forename: Anna-Greta
authors.initials: AG
authors.lastname: Mamhidir
mesh_terms: D055318:Evidence-Based Nursing / Q000379:methods*; D017144:Focus Groups; D006801:Humans; D009741:Nursing Staff, Hospital / Q000523:psychology*; D003668:Pressure Ulcer / Q000451:nursing / Q000517:prevention & control*; D036301:Qualitative Research; D058996:Quality Improvement; D017592:Skin Care / Q000379:methods; D013548:Sweden
keywords: hospital; implementation; pressure ulcer prevention; qualitative research