Using PURPOSE-T in clinical practice: A realist evaluation.

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.