Background: Pressure ulcer prevention is a critical patient safety indicator for acute care hospitals. An innovative\npressure ulcer prevention care bundle targeting patient participation in their care was recently tested in a cluster\nrandomised trial in eight Australian hospitals. Understanding nurses� perspectives of such an intervention is\nimperative when interpreting results and translating evidence into practice. As part of a process evaluation for the\nmain trial, this study assessed nurses� perceptions of the usefulness and impact of a pressure ulcer prevention care\nbundle intervention on clinical practice.\nMethods: This qualitative descriptive study involved semi-structured interviews with nursing staff at four Australian\nhospitals that were intervention sites for a cluster randomised trial testing a pressure ulcer prevention care bundle.\nFour to five participants were purposively sampled at each site. A trained interviewer used a semi-structured\ninterview guide to question participants about their perceptions of the care bundle. Interviews were digitally\nrecorded, transcribed and analysed using thematic analysis.\nResults: Eighteen nurses from four hospitals participated in the study. Nurses� perceptions of the intervention are\ndescribed in five themes: 1) Awareness of the pressure ulcer prevention care bundle and its similarity to current\npractice; 2) Improving awareness, communication and participation with the pressure ulcer prevention care bundle;\n3) Appreciating the positive aspects of patient participation in care; 4) Perceived barriers to engaging patients in\nthe pressure ulcer prevention care bundle; and 5) Partnering with nursing staff to facilitate pressure ulcer\nprevention care bundle implementation.\nConclusions: Overall, nurses found the care bundle feasible and acceptable. They identified a number of benefits\nfrom the bundle, including improved communication, awareness and participation in pressure ulcer prevention care\namong patients and staff. However, nurses thought the care bundle was not appropriate or effective for all patients,\nsuch as those who were cognitively impaired. Perceived enablers to implementation of the bundle included\nfacilitation through effective communication and dissemination of evidence about the care bundle; strong\nleadership and ability to influence staff behaviour; and simplicity of the care bundle.
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