Abstract：
OBJECTIVE: To explain how the clinical and organisational context influenced the way the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) is used by nursing staff to support their clinical judgement and decision making about care planning and delivery.
METHODS: A realist process evaluation was undertaken in a large acute hospital trust using mixed methods incorporating organisational policy review, staff semi-structured, ethnographic observation of clinical care and patient record review. Approximately 75 h of ethnographic field work involving 72 patients, 15 patient record reviews and 16 staff interviews were undertaken on 4 wards.
RESULTS: Findings suggest PURPOSE-T assisted nurses differently depending on their level of experience. Those with less experience use it as an educational guide, while those with more experience made an initial clinical judgement and used PURPOSE-T as a safety net to ensure they hadn\'t missed anything. Nurses were concerned about demonstrating good documentation of assessment, care planning and delivery in order to underpin consistent communication about care and because they had an underlying fear of being blamed if things went wrong. There is an array of other contextual features that impact the planning and delivery of pressure area care that go beyond the use of PURPOSE-T alone, including systematic equipment provision, competing patient safety initiatives and rehabilitation requirements.
CONCLUSIONS: The findings reinforce the assertion that PU-RAIs are complex interventions and could inform the development of a more integrated system of care which takes into account the contextual features associated with PU prevention in modern hospitals.
METHODS: A realist process evaluation was undertaken in a large acute hospital trust using mixed methods incorporating organisational policy review, staff semi-structured, ethnographic observation of clinical care and patient record review. Approximately 75 h of ethnographic field work involving 72 patients, 15 patient record reviews and 16 staff interviews were undertaken on 4 wards.
RESULTS: Findings suggest PURPOSE-T assisted nurses differently depending on their level of experience. Those with less experience use it as an educational guide, while those with more experience made an initial clinical judgement and used PURPOSE-T as a safety net to ensure they hadn\'t missed anything. Nurses were concerned about demonstrating good documentation of assessment, care planning and delivery in order to underpin consistent communication about care and because they had an underlying fear of being blamed if things went wrong. There is an array of other contextual features that impact the planning and delivery of pressure area care that go beyond the use of PURPOSE-T alone, including systematic equipment provision, competing patient safety initiatives and rehabilitation requirements.
CONCLUSIONS: The findings reinforce the assertion that PU-RAIs are complex interventions and could inform the development of a more integrated system of care which takes into account the contextual features associated with PU prevention in modern hospitals.
摘要：
目的：解释临床和组织背景如何影响护理人员使用压疮风险一级或二级评估工具（PURPOSE-T）的方式，以支持他们对护理计划和分娩的临床判断和决策。
方法：在一家大型急性医院信托基金中，采用了包含组织政策审查的混合方法，进行了现实主义的过程评估。员工半结构化，临床护理的人种学观察和患者记录回顾。大约75小时的人种学现场工作，涉及72名患者，在4个病房进行了15例患者记录审查和16例工作人员访谈。
结果：研究结果表明，PURPOSE-T辅助护士的经验水平不同。经验较少的人将其用作教育指南，而那些有更多经验的人做出了初步的临床判断，并使用PURPOSE-T作为安全网来确保他们没有遗漏任何东西。护士们担心展示良好的评估文件，护理计划和交付，以支持有关护理的一致沟通，因为他们有潜在的恐惧，如果事情出错，会受到指责。还有一系列其他上下文特征，这些特征会影响压力区域护理的计划和交付，而不仅仅是使用PURPOSE-T，包括系统的设备供应，相互竞争的患者安全举措和康复要求。
结论：这些发现加强了这样的断言，即PU-RAIs是复杂的干预措施，可以为开发更综合的护理系统提供信息，该系统考虑了与现代医院PU预防相关的背景特征。
方法：在一家大型急性医院信托基金中，采用了包含组织政策审查的混合方法，进行了现实主义的过程评估。员工半结构化，临床护理的人种学观察和患者记录回顾。大约75小时的人种学现场工作，涉及72名患者，在4个病房进行了15例患者记录审查和16例工作人员访谈。
结果：研究结果表明，PURPOSE-T辅助护士的经验水平不同。经验较少的人将其用作教育指南，而那些有更多经验的人做出了初步的临床判断，并使用PURPOSE-T作为安全网来确保他们没有遗漏任何东西。护士们担心展示良好的评估文件，护理计划和交付，以支持有关护理的一致沟通，因为他们有潜在的恐惧，如果事情出错，会受到指责。还有一系列其他上下文特征，这些特征会影响压力区域护理的计划和交付，而不仅仅是使用PURPOSE-T，包括系统的设备供应，相互竞争的患者安全举措和康复要求。
结论：这些发现加强了这样的断言，即PU-RAIs是复杂的干预措施，可以为开发更综合的护理系统提供信息，该系统考虑了与现代医院PU预防相关的背景特征。
