A new conceptual model for how pressure ulcer risk is negotiated and adherence to preventative advice in the community setting

Aim(s): To identify potential factors affecting patient adherence to preventative advice and to explore how pressure ulcer risk is negotiated between nurse and patient in the community setting. Design: A qualitative research design using a pragmatist approach. Methods: Observation of interactions between nurse and patient, evaluation of documentation, and semi-structured interviews with 15 community patients following the nursing interaction. Data was analysed using the principles of Thematic Analysis. Results: Five overarching themes affected patient adherence to pressure ulcer preventative advice: Patient decision-making, difficulty implementing advice, carer involvement, trust in the nurse and the nursing approach. These factors were complex, individualised, dynamic, and context and time specific. How pressure ulcer avoidance was negotiated diverged according to the type of nursing approach adopted, which impacted on adherence. Conclusion: The new conceptual model identifies the importance of an open, participatory nursing approach to support shared decision-making. It accommodates the dynamic nature of patient factors, which affect their ability to acquire and understand PU advice and adhere to preventative strategies.