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Using PURPOSE-T in clinical practice: A realist evaluation
Susanne Coleman1, Joanne Greenhalgh2, Lisette Schoonhoven3
1Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
Journal of Tissue Viability
|July 20, 2024
Summary
The Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) aids nurses differently based on experience. Contextual factors significantly influence pressure ulcer prevention care planning and delivery.
Area of Science:
- Healthcare Management
- Nursing Practice
- Patient Safety
Background:
- Pressure ulcer risk assessment tools are crucial for effective care planning.
- Understanding the implementation context of such tools is vital for optimizing their use.
- The Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) is designed to aid clinical judgment in pressure ulcer prevention.
Purpose of the Study:
- To explore how clinical and organizational contexts influence the utilization of the PURPOSE-T by nursing staff.
- To understand how PURPOSE-T supports nursing staff's clinical judgment and decision-making in care planning and delivery for pressure ulcer prevention.
Main Methods:
- A realist process evaluation was conducted in a large acute hospital trust.
- Mixed methods included policy review, ethnographic observation (75 hours), patient record review (15), and staff interviews (16) across 4 wards.
- Data involved 72 patients and focused on the application of PURPOSE-T in clinical practice.
Main Results:
- PURPOSE-T usage varied by nursing experience: novice nurses used it as an educational guide, experienced nurses as a safety net.
- Nurses prioritized documentation for communication and to mitigate blame, highlighting concerns beyond the tool itself.
- Contextual factors like equipment provision and competing safety initiatives impact pressure area care delivery.
Conclusions:
- Pressure Ulcer Risk Assessment Instruments (PU-RAIs) are complex interventions.
- Findings suggest a need for integrated care systems considering contextual features in modern hospitals for effective PU prevention.
- Optimizing PU prevention requires addressing broader organizational and clinical factors alongside assessment tools.
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