Why do pressure injuries still occur? A multicenter qualitative study of nurses and caregivers.

Background: The frequent occurrence of pressure injuries despite their preventability raises important questions about our understanding of the barriers to care. This study explores the lived experience of nurses and caregivers in Singapore to establish a conceptual framework for better understanding of pressure injuries arising in the community. Methods: A multicenter qualitative study was conducted utilizing semistructured interviews and focused group discussions of nurses and caregivers of patients with pressure injuries. Data were collected with a narrative inquiry approach and analyzed with grounded theory. An iterative cycle of interviewing, coding, discussion, and reflection was conducted until theoretical saturation. Results: Ten inpatient nurses and 10 caregivers from the community were recruited. Analysis identified cognitive (awareness and caregiver training), emotional (motivation and empowerment), resource (human and infrastructural), and biomedical factors which collectively impacted the effectiveness of prevention. Additionally, constructs of learning and sustainability of caregiving played a crucial role in long term prevention. Limitation: The derived framework requires further validation with quantitative data and may not be generalizable to other cultural and economic populations. Conclusion: Multiple constructs have been identified to have a synergistic effect in prevention. Targeted measures should be implemented by healthcare institutions to better equip caregivers in prevention.