Exploring perceptions of pressure ulcer risk assessment and pressure ulcer prevention practice among registered nurses in the acute hospital setting

  • Michael Ellis

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


Background: Pressure ulcers are generally considered to be preventable healthcare associated harm yet are prevalent within the patient population receiving NHS care at a rate of approximately 4% or higher. More than 90 risk assessment tools currently exist with the aim of preventing pressure ulcers by identifying those at risk. Despite the wide availability of risk assessment tools, pressure ulcers continue to pose a significant challenge, this raises questions about the role of current risk assessment approaches. This study explores the way that RNs undertake patient risk assessment and how they make decisions about care.
Methodology: A phenomenological approach using a combination of 1 focus group and 9 semi-structured in-depth interviews was conducted. Thematic analysis techniques were used to code and analyse the data.
Results: A total of 14 RNs participated in the study. 3 main themes emerged from this study: Learning and training opportunities influence the way nurses perceive pressure ulcer risk and respond to triggers; Decisions about risk in pressure ulcer care are influenced by conscious and unconscious cognitive processes; Organisational and workforce factors contribute to a theory practice gap. RNs appear heavily influenced by leaning opportunities, both formal and informal in the way they build a mental model of risk and of pressure ulcer prevention care. Regardless of their mental model, there are concerns about the operationalisation of pressure ulcer prevention care, including risk assessment. The view they hold is that the context of practice: the impact of the organisation, changing healthcare roles and changing patient needs, restricts their ability to deliver best possible nursing care.
Conclusion: The RN holds a mental model of risk that is changeable based on the context in which they practice. This provides an opportunity to utilise practices such as “nudges” that facilitate pressure ulcer prevention. Changes within the healthcare team could be capitalised upon if the use of different roles within the team is well-thought out and properly structured for the benefit of risk reducing practices. An opportunity exists to revise the risk management paradigm to utilise technologies to more robustly deliver objective risk assessment methodologies to improve the reliability of good patient outcomes.
Date of Award19 Jun 2019
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorAlan Buckingham (Supervisor) & Zena Moore (Supervisor)


  • pressure ulcer
  • risk assessment
  • pressure injury
  • bed sore
  • harm reduction
  • nursing
  • healthcare
  • hospital

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