This is a Straussian grounded theory study about the impact of nurses’ values on pressure ulcer prevention. Semi-structured interviews were used to gather data from participants (n=16) who were recruited from the non-acute adult medical wards of 14 hospitals in one NHS Trust and a local university. The participants were asked to talk about their experiences of preventing and managing pressure ulcers and their values were elicited from their accounts. The data were analysed and interpreted with Straussian grounded theory. Nurses were found to work according to the value that they placed on pressure ulcer prevention, as this value influenced the manner in which they prioritised and delivered skin care to their patients. Similar links between nurses’ values and their delivery of care with regards to other aspects of nursing were also identified. The delivery of care to prevent pressure ulcers was found to be subject to clinical priorities and other factors. As a result, the majority of care to maintain skin integrity was delivered by nursing auxiliaries and students because nurses were busy doing other things. Despite this, nurses who place a high value on pressure ulcer prevention appear to be more proactive and determined to deliver care that protects the integrity of their patients’ skin than their peers. This is highlighted by the participants’ accounts of how their prioritisation and delivery of care to prevent pressure ulcers changed when the value that they placed on pressure ulcer prevention increased from low to high. This study also identified the manner in which the value that nurses place on pressure ulcer prevention is formed and evolves. The recommendations that arise from this study are: further testing of this grounded theory in other settings to increase its generalisability and a greater awareness of the impact that the value that nurses place on different aspects of patient care has on their delivery of care to patients, especially with regards to pressure ulcer prevention. Nurse education and training must also take into account some of the factors that help to form and change the value that nurses place on pressure ulcer prevention. Greater attention needs to be paid to the value that nurses place on different aspects of nursing in view of the relationship between nurses’ values and care delivery, if patients are to receive the best possible care.

This study attempted to investigate the impact of new technology, specifically tele-advice on community nurses' care of leg ulcers. Firstly, a stratified randomised controlled study was designed to measure the impact of using this technology on their levels of wound knowledge and confidence. An individual self-test questionnaire and an attitudinal scale measured nurses' knowledge and confidence respectively both pre and post-intervention. Secondly, a new visual wound assessment tool was designed to represent the state of the wound by a single numerical value; the State of the Wound Index (SWI). Thirdly, the impact of nurses' knowledge, confidence and patient variables was explored to assess their impact on the state of the wound as represented by SWI. The sample consisted of thirty-eight registered primary care nurses from two local NHS trusts in South Wales and their corresponding 38 patients with venous leg ulcers. Nurses were stratified according to their qualifications into experimental or control groups. Both groups were shown to have comparable levels of knowledge and confidence pre-intervention. Nurses in the experimental group received expert tele-advice by a Clinical Nurse Specialist (CNS) over a 12 week period regarding the care of their patient's leg ulcer, whilst those in the control group continued to care for their leg ulcer patients in the traditional way. hi the experimental group, nurses' level of knowledge increased significantly (p=0.02) whilst no improvement was observed for the control group. In terms of confidence, the experimental group reached near significance when extremely positive statements were excluded with no improvement observed for the control group. Results show that the intervention had a positively significant impact on nurses' wound care knowledge and level of confidence. A set of 18 tele-transmittable wound factors was identified by a panel of wound experts. These factors were ranked by another independent panel of leg ulcer experts and no significance could be established in their order of importance. These factors were then examined for their highest and lowest possible estimates for every wound in the sample both pre and post intervention using a Visual Analogue Scale (VAS). These estimated values formed the basis for 95% confidence interval estimates from which 100 virtual nurse assessed values were generated. These values were then used to generate SWI. This new index ranged from 0 (best possible state) to 100 (worse possible) and was seen to reliably increase when the wound deteriorated and decrease as the wound improved. Linear regression models were built to establish the relationship between SWI, patient variables and nurses' knowledge and confidence levels pre and post-intervention. These indicated that knowledge and confidence can have a positive impact on the healing process. This study has shown that there is great potential for the use of tele-advice in community nurses' care of leg ulcers. For this to succeed, it is recommended that further pre and post registration nurse training is provided to enhance their knowledge in wound care, especially in the areas of physiology and wound assessment.