Implementation Of Pressure Injury Prevention An Effect- And Process Evaluation With Focus On Promoting And Restraining Factors

Background: Studies on implementation processes point out the importance of multifactorial efforts to achieve success. This article describes and discusses results from an effect and process evaluation of implementing guidelines to prevent pressure injuries. Aim: To evaluate the effect of the implementation with focus on incidence of pressure injuries and pressure injury preventive activities. Degree of success is understood with inspiration from Alison Kitson's conceptual framework. Method: A cohort study. Quantitative data: Patient records, direct observation of the patient and use of pressure injury facilities. Qualitative data: Semi-structured focus group interviews. Analysis: Chi2-test, Fischer's Exact test or simple proportion and a hermeneutic approach inspired by Alison Kitson. Results: Incidence of pressure injuries was reduced. Promoting factors: Organisational - and management recognition, responsiveness to change, interdisciplinarity, visual leadership, a multifaceted learning approach and accessible discussion partners. Restraining factors: Challenges of standard practices, bad timing of project process and educational setting. Conclusion: Incidence of pressure injuries was reduced. The causes of success were recognition of evidence on management- and clinician levels, positive attitudes, practically oriented guidelines, high levels of motivation, receptiveness to change, interdisciplinarity, and a multifaceted approach towards learning and facilitators.