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.

Background Pressure ulcers are localized injuries to the skin and underlying tissue caused by pressure, shear or a combination of these. The consequences of pressure ulcers are contributing to higher risk of morbidity and mortality. It also increases costs to society and causing suffering affecting the quality of life for individuals. Research shows that patients often do not get access to those interventions with the highest evidence-based utility. Many times, there can be great differences within countries regarding interventions that reaches the patients. Aim The aim of the study was to describe pressure ulcers prevention by registered nurses in San José, Costa Rica. Method A qualitative design with semi-structured interviews was used. The study consisted of interviews with six registered nurses whereof one was an included pilot interview. The data process consisted of recording the interviews, transcription and a qualitative content analysis. Findings The main findings show that there is insufficient knowledge regarding pressure ulcer prevention and that there is a lacking ability to implement the existing knowledge into daily practice. Conclusion Strategies are needed to implement routines regarding pressure ulcer prevention and broader knowledge is needed to enable the registered nurses to follow these routines and to perform accurate and evidence based care. The lack of resources and time influence the ability to fulfil professional responsibilities regarding pressure ulcer prevention. The management have the important task to make sure that the needed knowledge and resources exists so that the staff can fulfil their work duties.

Bakgrund: Trycksår är en typ av skada som är vanligt förekommande inom sjukvården. Den är ofta smärtsam för den drabbade, både fysiskt som psykiskt, och är dessutom icke sällan svårläkt. Upplevelsen av att leva med trycksår kommer ofta i skymundan i arbetet kring trycksår. Det behövs en större förståelse för den drabbades upplevelse för att se till att de interventioner på området som vården kan använda också implementeras. Detta för att ge patienten en så god chans som möjligt till ett bra liv. Syfte: Syftet var att beskriva patienters upplevelse av att leva med trycksår. Metod: En litteraturöversikt på kvalitativa och kvantitativa artiklar hämtade från databaserna Cinahl Complete, PubMed och PsycInfo. En kvalitativ innehållsanalys har gjorts på det inhämtade materialet. Resultat: Med utgångspunkt från artikelanalysen identifierades fyra teman: ”smärta och obehag”, ”begränsningar i vardagen”, ”upplevelse av vården” och ”att blicka framåt”. Sammanfattning: Trycksår är en vårdskada som uppstår till följd av ett långvarigt tryck mot huden. Delar av kroppen som är extra utsatta är där huden ligger nära benet. Att ha trycksår är mycket smärtsamt såväl fysiskt som psykiskt tillsammans med känslor av av obehag och skam. De som drabbats av trycksår känner sig ofta missförstådda av vården och känner att deras upplevelse inte tas på allvar. / Background: A pressure ulcer is a common type of health care-inflicted injury. It is often painful for the patient stricken, both physically and psychologically, and is furthermore not seldom hard to heal. The patients experience of living with a pressure ulcer is often overlooked when it comes to dealing with pressure ulcers. There is a need for a greater understanding for the experience of the patient involved to make sure that the interventions that can be used also are implemented. This is to give the patient the chance of a life as good as possible. Aim: The aim was to describe patients experiences of living with pressure ulcers Method: A systematic review of qualitative and quantitative articles collected from the databases Cinahl Complete, PubMed and PsycInfo. A qualitative analysis has been performed on the material. Results: With the analysis of the articles as a starting point, four themes emerged: ”pain and discomfort”, ”restrictions in everyday life”, ”experience of health care” and ”looking forwards”. Summary: Pressure ulcer is a type of wound originating from long time pressure against the skin. Especially exposed areas of the body are located to where the skin is close to the bone. Having a pressure ulcer is very painful both physically and psychologically along with feelings of discomfort and shame. Those affected by pressure ulcer often feel misunderstood by health care and that their experience is not listen to.

Bakgrund: Trycksår uppstår i samband med vård och anses vara en vårdskada. För att bedöma svårighetsgraden av ett trycksår används internationellt standardiserat mätinstrument. Preventiva åtgärder och behandlingsåtgärder vid uppkomna trycksår är viktiga verktyg. Patienters upplevelser ger också vården en bättre förståelse för vad som hjälper, eller inte. Upplevelserna kan användas för att förbättra och effektivisera vården, samt främja ett personcentrerat förhållningssätt. Syfte: Syftet var att beskriva patienters upplevelser av att leva med trycksår. Metod: Metoden som användes var en litteraturöversikt. Vetenskapliga, kvalitativa artiklar valdes ut ur databaserna PubMed och CINAHL complete. Artiklarnas resultat sammanställdes sedan och presenterades i fyra olika teman. Resultat: Resultatet visade att patienterna blev mycket påverkade av sina trycksår, framförallt av smärta. Att ha blivit drabbad bidrog till en förtroendekris för vården. Konsekvenser var bland annat isolering, sömnpåverkan och förändrade sociala relationer. En del patienter blev negativt inställda till vården och andra fick ett annat perspektiv. Sammanfattning: Trycksåren påverkade patienternas hälsa. Patienterna påverkades av att vara beroende av andra, inte få rätt hjälp som behövdes samt kommunikationsmisstag och stressrelaterade faktorer. Genom denna uppsats förstärks värdet av sjuksköterskans hälsofrämjande arbete och vikten av patienternas upplevelser. Uppsatsen visar på betydelsen av att arbeta personcentrerat och inkluderande vid patientnära arbete. / Background: Pressure ulcer that occur during institutional care is considered a healthcare injury. To assess the level of injury, an international standardized assessment tool is used. The preventative arrangements and treatment care are important tools when treating, and preventing, ulcers. The patients’ experience may influence which care that works, care quality, care efficiency and encourage patient-centered approach.  Aim: The aim was to describe patients’ experiences of living with pressure ulcers.  Method: The method used was a literary survey. Scientific articles of qualitative nature that followed preset inclusion-criteria were chosen from the databases PubMed and CINAHL complete. The results of each article were then complied and presented in the survey under four themes.  Results: The result showed that the patients were heavily affected by their pressure ulcer, they were especially affected by pain. Some consequences were; isolation, negative effects on sleep as well as changed social relations. Some patients were negative toward health care as a result, and others developed a new perspective on health care.  Conclusion: Pressure ulcers affected patients’ health. Patients’ health was affected by dependency on others, not receiving the help needed, as well as communication difficulties and stress factors. Through this survey the importance of person-centered, inclusive care is highlighted as well as the health-strengthening work of the nurse.

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Yes / A significant proportion of healthcare that is delivered is wasteful, harmful and not evidence based. There are many wound care related guidelines, but their implementation in practice is variable. The Society of Tissue Viability (SoTV) published updated seating guidelines in 2017, but there is a lack of theoretical and conceptual clarity about how these guidelines are being utilised to inform clinical practice. Therefore, the aim of this paper is to generate a theory that can be used to incorporate the SoTV seating guidelines into policy and clinical practice. Methods: We critically reflected on data from an evaluation study utilising systems-thinking approach, informed by implementation and safety science using wider literature as well as our expertise to generate a guideline implementation theory. Discussion: Factors that facilitate or hinder the incorporation of the SoTV guidelines into policy and practice were characterised. We conceptualised the implementation of these guidelines into policy and practice into a Translation or Implementation into Policy or Practice (TIPP) theory with distinct stages, that we called liminal spaces. Knowledge of the guidelines, and the agency or authority to effect change, are key factors in the translation of these guidelines into clinical practice. Conclusion: Our theory is that there are liminal spaces in the implementation trajectory of these guidelines into practice, which have their own characteristics. This theory provides a framework that can be used to underpin guidelines strategies to embed skin and wound care guidelines into policy and clinical practice in order to improve patient care.

The purpose of this thesis was to quantify the cost of care and treatment of pressure ulcers in Thomayer University Hospital with polyclinic (FTNsP) in Prague. Present pressure ulcer monitoring system was analyzed and a transformation of the records collected by this systém in the period 2005 - 2010 was performed in order to derive the necessary data - especially the number of patient-days, displayed by severity of the pressure ulcers. Data on expenditure of materials and pharmaceuticals was obtained by questionnaire survey, conducted in 2009 among the nursing staff. The description of the incidence of pressure ulcers in FTNsP, analysis of the effect of the use of anti-decubitus mattress on the incidence of pressure ulcers and bedsores costs per patient and for the entire hospital according to a single component of direct costs and costs of extended hospital stay are the results of the thesis.

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