Implementing a Nurse Led Initiative to Prevent Pressure Ulcers

PICO Question Dissemination and Implementation

Evidence-Based Recommendation:

Based on the synthesis of the peer-reviewed research previously reported, the evidence-based recommendation for pressure ulcer prevention and management in long-term care settings requires a multi-faceted approach. Although every patient’s condition and needs are unique, this multifaceted approach generally includes performing regular risk assessments of elderly patient using validated and reliable tools, implementation of evidence-based preventive measures, and ongoing staff training and evaluation to ensure consistent application of the recommended preventive practices described above.

External Audience:

The external audience that would most significantly benefit from this recommendation includes the general public, particularly those with elderly family members in long-term care (Scheerbaum et al., 2024). In addition, conventional and social media outlets specializing in reporting on healthcare quality (Khan & Loh, 2022) and healthcare policymakers who are not directly involved in the implementation process (Bullock et al., 2021) also represent important members of the external audience for this initiative.

Stakeholders:

The primary internal stakeholders that are crucial for the successful implementation of this initiative include long-term care facility administrators (Carbone et al., 2022), the nursing staff who are employed in these facilities, the direct care providers (including physicians), the patients and their family members, and most particularly the nursing leaders who are employed within these facilities (Garcia et al., 2016). Given that the already large elderly population in the U.S. (e.g., individuals aged 65 years and over) represents the fastest growing demographic in the nation (U.S. Older Population, 2024), these stakeholders will invariably face larger elderly populations at risk for pressure ulcers in the foreseeable future.

Involving Stakeholders and Audiences:

To effectively involve stakeholders and audiences, a variety of methods can be employed. For instance, methods such as in-person presentations and workshops for internal stakeholders as well as social media and Web site updates for external audiences. In addition, email newsletters for both groups have proven effectiveness (Humbles, 2019). In sum, nursing leaders should taken advantage of the most cost-effective engagement strategies available and these may differ depending on the venue.

It is also important to note, however, that all content should be specifically customized to the stakeholders and type of audience targeted. For example, detailed technical information should be provided for healthcare professionals while simplified summaries are used for external audiences. Finally, interprofessional strategies such as collaborative meetings and transdisciplinary training sessions are also essential for successful, comprehensive implementation (Merriman et al., 2020).

Dissemination and Implementation:

Critical elements for successful dissemination and implementation of this initiative include ensuring clear communication of recommendations to all stakeholders and the development of a structured implementation plan with contingency planning for unexpected challenges that may arise during or post-implementation. Likewise, regular monitoring and evaluation, feedback mechanisms for continuous improvement, and ensuring accessibility of information to all relevant parties are also important elements of the dissemination and implementation of this initiative (Devi et al., 2023).

Required Resources:

Required resources for this initiative include the requisite financial allocations for staff training and equipment as well as physical resources such as educational materials and preventive equipment which will vary from facility to facility. In addition, interprofessional resources including the allocation of time for collaborative efforts and the development or update of relevant policies and procedures are also essential resources required for the initiative dissemination and implantation as discussed further below.

Dissemination Plan:

For external audience dissemination, most especially content that targets the general American public and mainstream media, the plan should include creating easy-to-understand fact sheets and corresponding infographics, developing educational videos and organizing public awareness events concerning the risk factors for pressure ulcers and evidence-based preventative measures. In addition, ongoing engagement with local media and leveraging popular social media platforms to share information and success stories are also integral parts of the dissemination plan.

Potential Barriers:

Some of the potential barriers to implementation and dissemination include inherent resistance to change from staff members. In fact, resistance to change may represent the biggest potential barrier to the successful implementation of this initiative since it requires internal stakeholders moving from their “comfort zones” by learning new protocols – even if they are in the best interests of patients. Beyond this challenge, limited financial resources, time constraints for training, inconsistent application of new practices, lack of interdisciplinary cooperation, difficulty in measuring immediate results, and possible resistance from patients or families to new preventive measures are also significant potential barriers. Taken together, it is clear that addressing these barriers proactively will be crucial for the successful implementation of the evidence-based recommendations for pressure ulcer prevention in long-term care settings.

References

Bullock, H. L., Lavis, J. N., Wilson, M. G., Mulvale, G., & Miatello, A. (2021). Understanding the implementation of evidence-informed policies and practices from a policy perspective: a critical interpretive synthesis. Implementation science: IS, 16(1), 18.

Carbone, S., Kokorelias, K. M., Berta, W., Law, S., & Kuluski, K. (2022). Stakeholder involvement in care transition planning for older adults and the factors guiding their decision-making: a scoping review. BMJ open, 12(6), e059446.

Devi, R., Martin, G. P., Banerjee, J., Gladman, J. R., Dening, T., Barat, A., & Gordon, A. L. (2023). Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study. BMJ Quality & Safety, 32(11), 665–675.