care staff believed they had a good understanding of pressure ulcers, the various causes and prevention procedures (e.g., repositioning). However, many of the care staff were unable to specify any particular pressure ulcer prevention protocols endorsed by the home

A total of 25 participants took part in semi-structured, face-to-face interviews from three nursing home sites which provide a range of care services including nursing, dementia, residential, respite, palliative and convalescent care

Some of the authors have previously worked as a healthcare assistant [JL] or a nurse

Face-to-face interviews were conducted at the participant’s place of work.

Sample size was based on data saturation which was assessed using the criteria proposed by Francis et al. (2010), whereby data collection can cease when no additional codes emerge within three consecutive interviews following the analysis of at least ten interviews.

The managers (nursing home and NHS) and tissue viability nurses were contacted via an invitation letter and a follow-up phone call.

Purposive sampling was used to recruit registered nurses and healthcare assistants working in nursing homes and specialist nurses who regularly provide wound care advice and training to nursing home care staff in the North West of England (e.g., tissue viability nurses).

Documentation was used to communicate the care a person needed in the future but also the care they had received, with the nurses relying on the healthcare assistants to inform them of any changes to the residents.

attendance was usually poor; perceived reasons for this included a curfew on training due to poor staffing levels and financial reasons.

wished to correct any wrong or biased information given by outside agencies including pharmaceutical companies.

Nursing home staff spoke enthusiastically about training and the importance of keeping up-to-date with practices

participants within this study reported feeling that within society pressure ulcers are a consequence of a lower quality of care.

Skin champions or link nurses have been introduced within some services (including nursing homes) and they are members of the team who are trained by specialist nurses to disseminate, facilitate and promote the use of research-informed wound care practices

Effective teamwork within the multidisciplinary team was an important factor as indicated by the value the nursing home care staff placed on the input from the tissue viability nurses.

two types of communication: formal and informal.

Leadership and supportive team structures enable staff to feel that they are working towards achieving their goal and facilitate the integration of the various staff roles (Hartmann et al., 2016).

pressure ulcer prevalence has been found to be associated with staff cohesion

Teamwork and effective communication channels are consistently reported as facilitators in the prevention of pressure ulcers

The small number of participating nursing homes was a limitation of the current research and this is similar to other studies (e.g., Tilden et al., 2013).

he findings from this study will inform a theory and evidence-informed intervention to facilitate the implementation of pressure ulcer prevention guidelines

Taking such a deductive approach to data analysis assisted with the identification of the new barriers and facilitators which previous studies have not identified (e.g., fear of being reported to the Care Quality Commissioners).

The findings confirm the need for an intervention to support nursing home care staff in their pressure ulcer prevention practices, with a particular focus on increasing knowledge, improving skills and providing a supportive environment using the appropriate behaviour change techniques.

to explore how the behaviours of healthcare workers influence the prevention of pressure ulcers in nursing homes.

care staff can become the potential target for behaviour change interventions

communication and positive attitudes towards pressure ulcer prevention have been described as facilitators

Understaffing, high staff turnover and limited staff knowledge are the barriers often reported for the limited adherence to pressure ulcer prevention guidelines

treatment costs have previously been estimated to range from £1214 for a Stage 1 pressure ulcer to £14,108 for a Stage 4 pressure ulcer

Risk factors for pressure ulcers include, but are not limited to, increasing age, poor mobility, poor nutrition and multi-morbidity

good working relationships, both within and between teams, facilitated pressure ulcer prevention

more training for the nursing home staff is required.

Fear of being reported to outside agencies such as the Care Quality Commission motivates nursing home staff to adhere to recommended pressure ulcer prevention practices.

to aid the prevention of pressure ulcers in nursing home settings.

influenced by several factors.

Knowledge and insight into these barriers and facilitators provide a theoretical understanding of the complexities in preventing pressure ulcers with reference to the staff capabilities, opportunities and motivation related to pressure ulcer prevention.

seven domains

seriously ill, elderly, have impaired mobility and/or poor nutrition; thus, many nursing home residents are at risk.

cause pain, immobility, and delay recovery

Pressure ulcers are areas of localised damage to the skin and underlying tissue