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J Wound Care. 2018 Jul 1;27(Sup7):S4-S10. doi: 10.12968/jowc.2018.27.Sup7.S4.

Factors in facilitating an organisational culture to prevent pressure ulcers among older adults in health-care facilities.

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Deer Lodge Centre, Winnipeg.
Associate Professor; Rady Faculty of Health Sciences, College of Nursing, University of Manitoba.



Despite the availability of high-quality clinical practice guidelines, pressure ulcers (PU) continue to develop among older adults in acute and long-term health-care facilities. Except during acute medical crisis or near end-of-life, most PUs are preventable and their development is a health-care quality indicator. The aim of this study was to understand which factors facilitate pressure ulcer prevention among adults over 65 years-of-age receiving care in health-care facilities.


A critical literature review from three scholarly databases examined components of organisational culture associated with PU prevention. Research papers involving adults >65 years-of-age who were admitted to acute and long-term health-care facilities with PU prevention programmes between 2010 and 2017 were included. A secondary manual search included literature discussing health-care organisational culture, with a total of 41 articles reviewed.


Based on a synthesis of this literature, the Factors Facilitating Pressure Ulcer Prevention Model was developed to depict five multilevel factors for PU prevention among older adults in health-care facilities. These five factors are: senior leadership, education, ongoing quality improvement, clinical practice, and unit level champions.


Ongoing prioritisation of these factors sustains PU prevention and assists health-care facilities to redefine their culture, expand education programmes, and promote accountability to improve health outcomes of older adults receiving care.


older adult; organisational culture; pressure ulcer; pressure ulcer prevention

[Indexed for MEDLINE]

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