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.
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.
摘要：
背景：众所周知，足跟卸载装置在临床实践中广泛用于预防足跟压力溃疡，即使缺乏健壮的，高质量的证据来告知他们的使用。
目的：探讨如何以及为什么使用（或不使用）足跟卸载装置，以及在足跟压疮高危人群中使用这些装置的原因。
方法：在一家大型英国医院的三个骨科病房中进行了一项人种学研究，作为现实主义者评估的一部分。进行了12次观察，观察49小时和35分钟的患者护理。共观察32例患者，对19名护理组成员进行访谈，并对3名病房管理人员进行深入访谈。
结果：尽管研究的重点是卸载设备，还观察到恒定的低压脚跟特定装置用于预防压疮，而卸载装置被认为适用于高风险患者或已经患有足跟压力性溃疡的患者。护理人员将病房经理的领导和组织活力护士专家的影响视为主动使用设备的关键机制。
结论：这项研究为试验设计提供了信息，因为它已经确定，需要对两种类型的脚跟特异性装置进行对照临床试验，以提供循证实践。在建立临床平衡阶段，让病房经理和组织活力护士专家参与进来可以改善招募。TweetableabstractHow,为谁,在什么情况下，设备可以预防足跟压疮？临床实践观察。
目的：探讨如何以及为什么使用（或不使用）足跟卸载装置，以及在足跟压疮高危人群中使用这些装置的原因。
方法：在一家大型英国医院的三个骨科病房中进行了一项人种学研究，作为现实主义者评估的一部分。进行了12次观察，观察49小时和35分钟的患者护理。共观察32例患者，对19名护理组成员进行访谈，并对3名病房管理人员进行深入访谈。
结果：尽管研究的重点是卸载设备，还观察到恒定的低压脚跟特定装置用于预防压疮，而卸载装置被认为适用于高风险患者或已经患有足跟压力性溃疡的患者。护理人员将病房经理的领导和组织活力护士专家的影响视为主动使用设备的关键机制。
结论：这项研究为试验设计提供了信息，因为它已经确定，需要对两种类型的脚跟特异性装置进行对照临床试验，以提供循证实践。在建立临床平衡阶段，让病房经理和组织活力护士专家参与进来可以改善招募。TweetableabstractHow,为谁,在什么情况下，设备可以预防足跟压疮？临床实践观察。
