Conectar
To gain consensus and prioritise barriers to effective pressure injury prevention for at-risk patients and to collaboratively generate, discuss and recommend intervention strategies that could address these prioritised barriers in the acute medical-surgical hospital context.
Nominal Group Technique.
Participants involved in pressure injury prevention across acute medical-surgical services in a tertiary hospital in Australia were purposively sampled. Pre-reading materials informed the discussion on barriers to prevention. Participants ranked 11 barriers that were collaboratively developed and identified practical context-specific solutions. Data were analysed using inductive content analysis.
Nine multidisciplinary participants prioritised three final barriers to effective pressure injury prevention: inadequate skin assessment and monitoring, competing priorities and workflow pressures and insufficient education and inconsistent knowledge. Proposed solutions focused on developing concise, accessible decision support tools such as quick reference flowcharts to enhance confidence, consistency and timeliness of appropriate pressure injury prevention practices.
The Nominal Group Technique enabled consensus-building, guided the development of actionable priorities and informed targeted intervention strategies to address key barriers in acute care nursing practice.
Findings from this study offer nurse leaders and researchers practical insights to co-create an intervention that drives evidence-based pressure injury prevention practice change in acute medical-surgical settings. Adoption of these targeted approaches may enhance hospital patient safety through pressure injury prevention implementation.
Reporting guideline for PRIority Setting on health research (REPRISE).
No patient or public contribution.
People with intellectual disability face significant barriers to accessing genetic healthcare, including during appointments. Many adults with intellectual disability are denied opportunities to discuss genetic testing that could improve their health and well-being. This study follows best practice in inclusive research, with co-researchers with intellectual disability co-leading alongside educational, disability and clinical experts to co-design and implement a respectful, accessible and inclusive national model of genetic healthcare.
This three-phase qualitative study positions people with intellectual disability as active researchers and partners throughout. Phase 1 will identify barriers and enablers to genetic healthcare for people with intellectual disability by engaging with approximately 100 participants—people with intellectual disability (with and without genetic testing experience), families/support people and genetic healthcare professionals—through interviews, focus groups, arts-based methods and yarning circles. Phase 2 will co-design and evaluate Guiding Principles, providing solutions to identified barriers and leveraging identified facilitators. Phase 3 will develop practical resources using workshops across Australia, guided by three Community Engagement Groups, including people with intellectual disability, families/support people and healthcare providers. This phase will also investigate strategies to optimise the national roll-out and implementation of resources among health professionals, people with intellectual disability and their families/carers. Aboriginal and Torres Strait Islander research methods are integrated throughout, led by Indigenous researchers.
Ethics approval has been granted by UNSW Sydney Human Research Ethics Committee (HC230353) and the Australian Institute of Aboriginal and Torres Strait Islander Studies (REC-0284). Participants will provide written consent using Easy Read or plain English materials. Findings will be disseminated through journal articles, conferences, websites and accessible formats, including Easy Read summaries and videos.
See the Graphical Abstract for a visual summary in online supplemental file 1
To investigate the effects of organisational interventions on the incidence, healing and management of pressure injuries in adult patients in acute hospital settings.
Systematic review.
The review included adult patients at risk of or with pre-existing pressure injuries in acute hospital settings, excluding mental health units, emergency departments or operating theatres. Interventions employed in the included studies were categorised using the Cochrane Effective Practice and Organisation of Care taxonomy.
Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Complete and Web of Science Core Collection were searched from 01 January 2012 to 31 December 2023.
Of 8861 records identified, 7 prevention studies met the inclusion criteria. Six studies reported reductions in pressure injury incidence. Included studies employed various combinations of 14 organisational strategies to enhance practices. Educational interventions were utilised in six studies, including educational meetings, materials and outreach visits. Other common strategies included audit and feedback, communities of practice and continuous quality improvement. The interventions targeted patients and clinicians, primarily nurses, with some involving multidisciplinary teams. The focus was on enhancing healthcare practices through systematic approaches and stakeholder engagement.
Organisational strategies targeting both patients and clinicians as part of an intervention bundle may enhance the prevention of pressure injuries in acute hospital settings. Further, high-quality effectiveness–implementation hybrid trials are required to evaluate these strategies.
Organisational factors influence clinicians' ability to implement evidence-based practices. The effectiveness of specific organisational strategies in acute settings is uncertain. Multiple organisational strategies targeting patients and clinicians may improve the implementability of a pressure injury prevention intervention.
This study adhered to PRISMA guidelines.
Neither patients nor the public were directly involved in this study.
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