Evaluation of the Nursing Culture Assessment Tool for Pressure Injury Prevention: A Mixed-methods Study

The nursing culture in long-term care (LTC) settings may affect quality measures such as pressure injury (PrI) rates.

The study was conducted to evaluate the relevance of an LTC facility's nursing culture to both their quality measures and their staff's perceptions of care in the context of PrI prevention.

Directors of Nursing (DONs) in 4 purposively selected Medicare/Medicaid-certified skilled nursing facilities were invited by phone, agreed to participate in the 5-day project, and completed an initial 7-item, facility-related survey. Their staff completed the Nursing Culture Assessment Tool (NCAT), a pen-and-paper instrument that comprises 19 items regarding 6 principal dimensions of nursing culture (behaviors, expectations, teamwork, communication, satisfaction, and professional commitment) and participated in focus groups to discuss the NCAT and its findings using standardized probes of the perception of survey salience in relation to PrI prevention practices. Staff, including registered nurses, licensed practical nurses, and certified nursing assistants employed either part- or full-time at each facility, were eligible for study participation over a 5-day period. All data collection and analyses were conducted by the authors. Facility-related data were descriptive only. Analyses of variance were used to test differences in standardized NCAT scores by facility, and focus group transcripts were coded and subjected to structured thematic content analysis.

One hundred, nine (109) people completed the NCAT, and 47 participated in focus groups. NCAT scores varied significantly by facility (P value range .001-.027). Staff comments about their respective facility's results focused primarily on communication and teamwork and included both agreement or disagreement with the facility's high or low scores in the context of PrI prevention, as well as suggestions for instrument administration.

Examination of nursing culture using the NCAT can provide new and targeted perspectives on how frontline workers perceive barriers and facilitators to delivery of PrI prevention in LTC. To support the evidence base regarding their values and beliefs, future research on effective workplace change in LTC settings will require nuanced assessment of the meaning and impact of the nursing culture on worker performance.