Healthcare Professionals' Experiences of the Causes of Recurrent Pressure Injuries-A Phenomenographic Study.

There are few previous studies regarding recurrent pressure injuries, most of which investigate surgical outcomes. From the perspective of the healthcare system, recurrent pressure ulcers may indicate shortcomings in quality, as preventive measures have failed not just once, but on several occasions. We aimed to examine how healthcare professionals working with wound care in specialised inpatient care perceived the causes of recurrent pressure injuries in patients with spinal cord injuries. A phenomenographic study using in-depth interviews was conducted. We identified four categories of the experienced causes of recurrent pressure injuries based on the respondents' subjective accounts: recurrent wounds are due to physical and mental vulnerability in the patient; recurrent wounds are due to a lack of compliance in patients and professionals; recurrent wounds are the result of fruitless endeavours to prevent them; recurrent wounds are due to neglect in healthcare. The causes were described as originating from different structural levels within society. However, preventive measures were primarily perceived as having been assigned at the patient and healthcare staff levels. The elderly were described as particularly vulnerable, whilst care and community interventions declined with increasing age. The participants emphasised that the changes in clinical practice that need to be prioritised primarily concern fundamental principles, in particular person-centred and inclusive care. Furthermore, a clearer division of responsibilities was highlighted as crucial, as patients in need of multimodal interventions have been found to fall between the cracks in a diagnosis-based healthcare system.