title: Nurses' perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study.
abstract: BACKGROUND
  Pressure ulcer prevention is a critical patient safety indicator for acute care hospitals. An innovative pressure ulcer prevention care bundle targeting patient participation in their care was recently tested in a cluster randomised trial in eight Australian hospitals. Understanding nurses' perspectives of such an intervention is imperative when interpreting results and translating evidence into practice. As part of a process evaluation for the main trial, this study assessed nurses' perceptions of the usefulness and impact of a pressure ulcer prevention care bundle intervention on clinical practice.
  
  
  METHODS
  This qualitative descriptive study involved semi-structured interviews with nursing staff at four Australian hospitals that were intervention sites for a cluster randomised trial testing a pressure ulcer prevention care bundle. Four to five participants were purposively sampled at each site. A trained interviewer used a semi-structured interview guide to question participants about their perceptions of the care bundle. Interviews were digitally recorded, transcribed and analysed using thematic analysis.
  
  
  RESULTS
  Eighteen nurses from four hospitals participated in the study. Nurses' perceptions of the intervention are described in five themes: 1) Awareness of the pressure ulcer prevention care bundle and its similarity to current practice; 2) Improving awareness, communication and participation with the pressure ulcer prevention care bundle; 3) Appreciating the positive aspects of patient participation in care; 4) Perceived barriers to engaging patients in the pressure ulcer prevention care bundle; and 5) Partnering with nursing staff to facilitate pressure ulcer prevention care bundle implementation.
  
  
  CONCLUSIONS
  Overall, nurses found the care bundle feasible and acceptable. They identified a number of benefits from the bundle, including improved communication, awareness and participation in pressure ulcer prevention care among patients and staff. However, nurses thought the care bundle was not appropriate or effective for all patients, such as those who were cognitively impaired. Perceived enablers to implementation of the bundle included facilitation through effective communication and dissemination of evidence about the care bundle; strong leadership and ability to influence staff behaviour; and simplicity of the care bundle.
authors.affiliation: NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, 4222 Australia.
authors.forename: Shelley
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Nursing Research Institute, St Vincent's Health Australia (Sydney) and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, NSW 2060 Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McInnes
authors.affiliation: School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558 Australia.
authors.forename: Marianne
authors.initials: M
authors.lastname: Wallis
authors.affiliation: Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, VIC 3220 Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Bucknall
authors.affiliation: Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD 4019 Australia.
authors.forename: Merrilyn
authors.initials: M
authors.lastname: Banks
authors.affiliation: NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, 4222 Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
keywords: Care bundle; Evidence-based practice; Implementation science; Knowledge translation; Nurses; Patient engagement; Patient participation; Pressure injury prevention; Pressure ulcer prevention; Process evaluation