A realist evaluation of devices used for the prevention of heel pressure ulcers: An ethnographic study of clinical practice

Clare Greenwood*, Jane Nixon, E. Andrea Nelson, Elizabeth McGinnis, Rebecca Randell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
50 Downloads (Pure)

Abstract

BACKGROUND: It is known that heel offloading devices are widely used in clinical practice for the prevention of heel pressure ulcers, even though there is a lack of robust, good quality evidence to inform their use.

OBJECTIVE: To explore how and why heel offloading devices are used (or not used) and reasoning behind their use in population at high risk of developing heel pressure ulcers.

METHODS: An ethnographic study was conducted as part of a realist evaluation in three orthopaedic wards in a large English hospital. Twelve observations took place, with 49 h and 35 min of patient care observed. A total of 32 patients were observed and 19 members of the nursing team were interviewed and in-depth interviews with the three ward managers were conducted.

RESULTS: Although the focus of the study was on offloading devices, constant low pressure heel specific devices were also observed in use for pressure ulcer prevention, whilst offloading devices were perceived to be for higher risk patients or those already with a heel pressure ulcer. Nursing staff viewed leadership from the ward manager and the influence of the Tissue Viability Nurse Specialists as key mechanisms for the proactive use of devices.

CONCLUSIONS: This study informs trial design as it has identified that a controlled clinical trial of both types of heel specific devices is required to inform evidence-based practice. Involving the ward managers and Tissue Viability Nurse Specialists during set up phase for clinical equipoise could improve recruitment. Tweetable abstract How, for whom, and in what circumstances do devices work to prevent heel pressure ulcers? Observations of clinical practice.

Original languageEnglish
Article number151785
JournalApplied nursing research : ANR
Volume76
Early online date19 Mar 2024
DOIs
Publication statusPublished - Apr 2024

Keywords

  • humans
  • heel
  • pressure ulcer/epidemiology

Fingerprint

Dive into the research topics of 'A realist evaluation of devices used for the prevention of heel pressure ulcers: An ethnographic study of clinical practice'. Together they form a unique fingerprint.

Cite this