Pressure ulcer practice in European hospitals: a scoping review

Pressure ulcer prevention and management belong to the core topics of nursing practice and research for decades. Numerous systematic reviews, clinical practice guidelines, and good practice documents are available, but pressure ulcer prevention and treatment may not be conducted following state-of-the-art methods in clinical practice.

The overall objective was to describe and map the available evidence regarding pressure ulcer prevention and treatment practices in European hospitals.

A scoping review was conducted in the databases Embase and Medline (via OVID) and CINAHL including descriptive empirical studies published between 2014 and 2024. The population included all healthcare professionals, and context was hospitals in the European Union.

Forty-six studies from 18 countries were included, describing 33 structure and 32 process aspects. The categories knowledge (n = 19) and attitudes (n = 11) were examined or identified by far the most frequently. Formal education and qualification were mentioned 10 times and personal interest and/or commitment 7 times. At the system level, the availability of and access to clear standards or protocols was mentioned most frequently. Most frequent process aspects included pressure ulcer risk assessment (n = 10), the type of risk assessment (n = 7), skin assessment (n = 10), repositioning (n = 9) and the use of support surfaces (n = 7).

More than 60 organizational, structural, and process characteristics were identified as potentially influencing pressure ulcer practice in European hospitals. Individual knowledge and attitudes and the availability of standards/protocols were most often investigated indicating a perceived priority in shaping pressure ulcer practice. Since all studies indicate knowledge deficits and a lack of implementation of basic prophylactic measures, there seems to be high potential to improve pressure ulcer prevention and enhance patient safety.