Senior nurses' control expectations and the development of pressure ulcers

The aim of this research was to establish whether the attitudes and expectations of senior nursing staff might adversely affect patient outcomes in the prevention of pressure ulcers. The hypothesis was that nursing locus of control affects clinical outcomes in patients. In particular, it affects departmental prevalence of pressure damage.

A population of nurses (n = 439) in an acute and community NHS trust were surveyed to test knowledge, control beliefs and value of pressure ulcer prevention relative to prevalence. The research was designed to provide different data against which to test the hypothesis: first, to assess acceptability of nurses' knowledge of prevention and appropriate use of risk assessment and equipment; second, to calculate a mean departmental pressure ulcer prevalence; and third, to measure locus of control and value, which is the focus of this article.

There were strong associations between departmental prevalence of pressure ulcers and attitudes of senior nursing staff. For example, the more that ward sisters believed they could control pressure ulcer prevention, the higher the prevalence of ulcers in their department. The more that sisters believed that they could not control prevalence, the lower the prevalence of ulcers.

The study shows that failure to account for beliefs, values and expectations of staff could lead to patient harm. It is suggested that it might be counterproductive to put great effort into developing clinical guidelines and refinement of risk assessment methods. The findings have important implications for nursing, and challenge the assumption that nurse leaders are universally beneficial to patients.