Nurses' experiences of hospital‐acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework

Author:

Team Victoria12ORCID,Bouguettaya Ayoub1,Qiu Yunjing13,Turnour Louise1,Banaszak‐Holl Jane C.4ORCID,Weller Carolina D.1ORCID,Sussman Geoffrey56,Jones Angela2,Teede Helena2ORCID

Affiliation:

1. School of Nursing and Midwifery Monash University Clayton Victoria Australia

2. Monash Partners Academic Health Science Centre Clayton Victoria Australia

3. School of Nursing and Midwifery University of Technology Sydney Ultimo New South Wales Australia

4. Department of Health Services Administrations, School of Health Professions The University of Alabama at Birmingham Birmingham Alabama USA

5. Austin Health Melbourne Victoria Australia

6. Department of General Practice, Faculty of Medicine, Nursing and Health Science Monash University Melbourne Victoria Australia

Abstract

AbstractWe investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI.

Funder

Department of Health and Aged Care, Australian Government

Publisher

Wiley

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