A nurse for older people by background, Susanne has worked across primary care, secondary care and voluntary sectors, leading multi-disciplinary organisational change/development, transitioning in the last 12 years to a research career.

Susanne is an NIHR Post-doctoral research fellow, key member of the Skin Portfolio academic team of the Surgical Interventions, Diagnostics and Devices (SIDD) division, at Leeds Institute Clinical Trials Research (LICTR) and a founding member of the Leeds Unit for Complex Intervention Development (LUCID,) at the University of Leeds.

Susanne used her substantive applied health research experience as part of the NIHR PURPOSE Programme (RP-PG-0407-10056) and HTA PRESSURE-2 trial (11/36/33) to establish an internationally recognised portfolio of Pressure Ulcer research. A

Susanne is a post-doctoral researcher she has a growing reputation as a qualitative and mixed methods researcher incorporating consensus methods, cognitive pre-testing methods, realist methodologies, innovative service user involvement and intervention development/evaluation with 6 funded awards (1 NIHR Development Grant (RP-DG-0218-10001), 2 NHS National Wound Studies, a European core outcome set study, 2 personal NIHR Fellowship scheme awards (Post-doc and DSE) and an ongoing HS&DR grant entiled Pressure Ulcer prevention at home (NIHR134029).

Presentation at The Society of Tissue Viability 2023 Conference

PURPOSE-T use in clinical practice: A realist evaluation

Objectives

After attending this session, persons will be able to:

• Have a greater appreciation of PURPOSE-T as a complex intervention
• Understand how PURPOSE-T influences clinical judgement, communication, care planning and delivery and how context shapes its use in clinical practice
• Consider the above in local implementation strategies

Abstract

Secondary Evaluation Tool – PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Research Programme (PURPOSE: RP-PG-0407-10056) and has since been implemented into routine care.  PURPOSE-T is different to standard RAIs as it includes a screening step to quickly identify those clearly not at risk and considers whether a patient already has a PU to prompt treatment.

Methods – A realist evaluation was undertaken to facilitate a deeper understanding of ‘what works, how, for whom, in what circumstances and to what extent [1-2]. This type of evaluation seeks understanding of causality via consideration of programme theories, to clarify how different contexts elicit particular nursing team responses and give rise to different outcomes. A combination of methods including a literature review, semi-structured interviews with staff and patients, record review and observation were used.

Results – Programme theories and supporting evidence relating to the use of PURPOSE –T in informing clinical judgement; prompting care planning and delivery and; facilitating multi-disciplinary and patient communication about pressure ulcer risk will be explored in this presentation.

Conclusion – Like other Pressure ulcer Risk Assessment Instruments, PURPOSE-T is a complex intervention as its delivery contains several interacting components [3] including the assessment itself, the potential outcomes and decisions about care interventions set within the delivery context of complex health care environments. Understanding this pathway will facilitate how PURPOSE-T can be used to maximally benefit routine practice and future evaluation methods. 

Acknowledgement – This report is independent research arising from a Post -Doctoral Research Fellowship (PDF-2016-09-054) supported by the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health. 

References

1. Pawson, R. and N. Tilley, Realist Evaluation, B.C. Office, Editor. 2004
2. Wong, G., et al., RAMESES II reporting standards. Bmc Medicine, 2016.
3. Skivington, K., et al., A new framework for developing and evaluating complex      interventions: update of Medical Research Council guidance. BMJ, 2021. 374:2061.

Presentation at the WReN Scientific Meeting, Glasgow, May 2022

Pressure ulcer risk assessment – barriers and levers to national and international implementation

Objectives

After attending this session, persons will be able to:

• Understand the need for evidenced-based pressure ulcer risk assessment
• Know where to gain further information about PURPOSE-T and supporting evidence
• Consider barriers and levers for evidenced-based pressure ulcer risk assessment in clinical practice

Abstract – The need for an evidenced-based Pressure Ulcer Risk Assessment Instrument was identified following a risk factor systematic review and a review of the content, development, testing and practical use of existing RAIs (1). This work identified limitations in instrument development methods, raising concern about their content validity and use in clinical practice.

PURPOSE-T was developed as part of an NIHR funded Research Programme (PURPOSE: RP-PG-0407-10056) using adapted ‘gold standard’ instrument development methods (1). PURPOSE-T is different to other RAIs as it incorporates a screening stage; a full assessment stage; the use of colour to support decision-making; and decision pathways, which make a distinction between patients with an existing PU(s) who require secondary prevention/treatment and those at risk who require primary prevention. It incorporates skin status and perfusion, important risk factors which are not universally incorporated into RAIs.

PURPOSE-T has since been implemented into routine care in acute and community Trusts and hospice settings with barriers and levers to implementation identified throughout the process. Evaluation of its impact on processes of care and outcomes is ongoing, with methods being adapted due to the COVID pandemic.

Acknowledgement – This presentation presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-0407-10056). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

References – PURPOSE Monograph, Nixon2015