No abstract

No abstract

ObjectivesTo investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors.DesignMultilevel approach to data from 2 cross-sectional studies.Settings4 hospitals in Norway were studied.Participants1056 patients at 84 somatic wards.Primary outcome measureHAPU.ResultsSignificant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs <70 (OR 2.70 (95% CI 1.54 to 4.74)), Braden scale total score (OR 0.73 (95% CI 0.67 to 0.80)) and overweight (body mass index 25–29.99 kg/m2) (OR 0.32 (95% CI 0.17 to 0.62)).ConclusionsThe fact that the odds of HAPU varied across wards, and that across-ward variance was reduced when the selected ward-level variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients.

Patients in intensive care units are at high risk of developing pressure injuries and moisture-associated skin damages. Prevention and care rely much on intensive care nurses' competency and attitudes. This study explored intensive care nurses' experience, knowledge and bedside practice in prevention and care of pressure injuries and moisture-associated skin damages with a descriptive qualitative design. Six focus groups (n = 25) were carried out in three University hospitals, two in Norway and one inIceland. Interviews were guided by a questioning route, recorded and transcribed verbatim before an inductive content analysis. Three interconnected main categories related to nurses' experience, knowledge and bedside care were identified: (a) nursing; (b) context; and (c) patients. Intensive care nurses recognise patients' risk of developing pressure injuries, as well as their continuous need of personal hygiene because of leakage of body fluids. Nurses were therefore attentive to skin inspection and preventive care but felt insecure and in need of expert help in pressure injury wound care. It varied whether nurses had access to suitable beds and mattresses and experts in wound care. ABCD had to be before E-verything else, but the skin had higher priority in long-stay compared with short-stay patients.critical care nursing, focus groups, knowledge, moisture-associated skin damage, pressure injury/ulcer Key Messages • intensive care patients are at high risk of developing pressure injuries because of a complex set of internal and external factors, leading to increased morbidity and mortality • limited research exists on intensive care nurses' knowledge and experience of prevention and treatment of pressure injuries, including moistureassociated skin damages