Optimizing the deployment of nurse champions to prevent and manage pressure ulcers in-hospital: the CHAMPION study

Pressure ulcers are injuries to the skin and underlying tissue caused by prolonged pressure or shear forces. Despite ongoing prevention efforts, they still occur regularly in hospital wards and intensive care units (ICUs). Nurse champions play an important role in preventing pressure ulcers by supporting, motivating, and educating their colleagues. However, in daily practice they often face challenges that limit their ability to fully perform and maximize the impact of their role.

Aim

The CHAMPION study aimed to explore how nurse champions for pressure ulcer prevention can increase their impact through individual coaching. The coaching focused on strengthening their leadership, autonomy, and control over own practice. 

Approach

The study was conducted across twelve departments in two academic hospitals: four intensive care units, four medical wards, and four surgical wards. Within each department type, two wards received the intervention and two served as controls. The project consisted of two work packages. In the first, interviews with nurse champions, patients, nurses, and nurse managers explored barriers and facilitators, but also the needs and experiences. Measures of leadership, autonomy, and control over own practice were collected with questionnaires, alongside pressure ulcer prevalence assessments. In the second work package, these measurements and interviews were repeated to evaluate and compare the effects of the coaching intervention.

Collaborative partners

The project brought together nurse champions, nurse managers, and nursing staff from participating departments in two academic hospitals. The collaboration also included nursing science researchers, wound care specialists, an implementation expert, and a quality improvement advisor. This multidisciplinary partnership was essential because it combined practical expertise from clinical care with scientific knowledge. The collaboration ensured that the study addressed real-world challenges while maintaining a strong evidence-based approach, increasing the relevance and applicability of the findings for healthcare practice.

Results 

The reintroduction of pressure ulcer prevalence measurements proved to be a valuable intervention in itself. Nurses became more aware of pressure ulcer rates and ward-specific risk factors, which stimulated additional education for both nurse champions and staff. Nurse champions described leadership mainly as motivating and supporting colleagues, although leadership skills were not always fully utilized. Autonomy and control over own practice were found to be less familiar concepts. The study also identified opportunities to involve patients more actively in pressure ulcer prevention, strengthening collaboration between patients and healthcare professionals.

Future perspectives

The CHAMPION study has already resulted in a publication in the Dutch nursing journal TVZ. Three additional manuscripts are planned for submission to international peer-reviewed journals. The lessons learned are applicable beyond pressure ulcer prevention and may support nurse champions in other clinical domains. Long-term sustainability of the project outcomes is supported by the continued use of pressure ulcer prevalence measurements, which help maintain awareness, monitoring, and quality improvement activities within healthcare organizations.