Microentorno Factores determinantes:

There are no studies that have directly examined the value that people place on pressure ulcer prevention, but a number of opinion papers have been published on this topic.

There is a view amongst some tissue viability researchers that pressure ulcer prevention like many aspects of tissue viability is undervalued by healthcare professionals and society at large. This is because the relative importance of pressure ulcer prevention does not appear to be adequately reflected in clinical practice or government policy (Fletcher 2005; Harding 2005; Stephen-Haynes 2005). The level of public interest in pressure ulcers is less than that of other medical conditions like cancer, which means that pressure ulcers have a low public profile (Cherry 2006). These views are largely based on expert opinion but they suggest that the value placed on pressure ulcer prevention by healthcare professionals like nurses merits investigation.

There are other reasons that have been put forward to explain why pressure ulcers appear to be undervalued. One view is that healthcare issues like pressure ulcer prevention are often underappreciated because they affect the vulnerable in society, people without any political authority or healthcare professionals without any influence (Barker 1996; Hennessy and Spurgeon 2000). This assertion is largely predicated on expert opinion of the process by which healthcare policy is formulated and it is supported by some more robust evidence. The view that a low value is placed on the care of vulnerable groups like the elderly is reflected in their colloquial and somewhat pejorative description as “Cinderella services” by those who view these vulnerable groups as non-productive (Barker 1996). This means that

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there are people outside the field of tissue viability who feel that some aspects of healthcare like pressure ulcer prevention which are undervalued because of the type of patients that they affect.

Perhaps, the low value that has been placed on some aspects of healthcare like pressure ulcer prevention is due to the lack of a medical professional lead. Having a medical lead on a healthcare issue is important because some doctors have such a high level of political and professional influence that they directly or indirectly affect the government’s healthcare policy (Walt 1994). This suggests that the lack of a medical lead may be one reason why pressure ulcer prevention may be undervalued compared to other aspects of healthcare. The importance of a medical lead appears to be reflected in the manner that the

government has emphasised the important of infection control and pressure ulcer prevention. Infection control falls under the domain of the medical speciality of

microbiology while pressure ulcer prevention falls under the largely nursing speciality of tissue viability (Butler 2008). Statistics about the number of patients with nosocomial infections are readily available, but it is difficult to obtain the same information about patients with pressure ulcers. This lends itself to the view that the fact that infection control falls under the medical speciality of microbiology has given it a direct medical influence unlike pressure ulcer prevention and is part of the reason why infection control has a higher public and political profile.

There are other explanations which may account for the differences in the profile of infection control and pressure ulcer prevention. One alternative explanation is that some infections like swine flu are immediately life threatening in comparison to some grades of pressure ulcers. Whatever the case may be, it is clear that infection control has a higher public and political profile that pressure ulcer prevention.

Infection control is an interesting parallel to pressure ulcer prevention in many respects. In the last twenty years the government has published a number of policies, guidelines and targets pertaining to both of these issues. These measures to prevent infections and pressure ulcers appear to have had a different impact on clinical practice. The number of patients with nosocomial infections appears to be falling, and the public’s awareness of infections like MRSA has never been higher. On the other hand, the number of patients with

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pressure ulcers does not appear to have changed and there seems to be a lack of awareness about how to prevent pressure ulcers amongst the public.

There are no studies that have been undertaken which have solely focused on the value that is placed on pressure ulcer prevention by nurses. The research that has been undertaken thus far, has inferred the value that nurses place on pressure ulcer prevention from their attitude and behaviour towards the maintenance of skin integrity. Most of these studies suggest that nurses place a low value on pressure ulcer prevention and perceive it to be a lower priority than other aspects of nursing. The prevailing view amongst tissue viability researchers appears to be that pressure ulcer prevention is undervalued by healthcare professionals and the general public (Harding 2005; Cherry 2006; Butler 2008), but this view is supported by a small amount of robust evidence. This indicates that ascertaining the value that nurses place on pressure ulcer prevention may shed new light on the pressure ulcer related practices.

Ascertaining the value that nurses’ place on pressure ulcer prevention may also be useful for other reasons. There is a lot of robust empirical evidence which shows that a person’s values have a direct impact on their beliefs, attitudes and actions (Bernard 2002; Pakizeh 2005). Therefore, it is possible that nurses’ behaviour and attitude towards the maintenance of skin integrity may be underpinned by the value that they place on pressure ulcer

prevention. Understanding nurses’ values may also help to shed light on why there are inconsistencies between nurses’ attitude and behaviour towards the maintenance of skin integrity.

If the value that nurses place on pressure ulcer prevention can be established, then it is possible that their pressure ulcer related attitude and behaviour can be changed through an appropriate educational programme. This is because research studies have shown that education can alter a person’s values, behaviour and personality as it facilitates critical self- evaluation (Green 1990; Hall 1997; Seedhouse 2005). Therefore, if the value that nurses place on pressure ulcer prevention can be determined; then an educational programme can be created which may result in the delivery of care that is consistent with best practice and a reduction in the number of people with pressure ulcers.

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Having established that the value that nurses place on pressure ulcer prevention is a topic that merits further investigation, it is now time to consider what is known about the relationship between nurses’ values and actions.