Nurses’ perceptions of the root causes of community‐acquired pressure ulcers: Application of the Model for Examining Safety and Quality Concerns in Home Healthcare

Aims and objectives To explore how the context of care influences the development of community‐acquired pressure ulcers from the perspective of nurses working in home healthcare settings, to identify and categorise the factors perceived as contributing to the development of these ulcers using the Model for Examining Safety and Quality Concerns in Home Healthcare, and to explore how these risks are managed in practice. Background Pressure ulcer reduction is a priority in both hospital and community settings. Evidence suggests the factors affecting safety and performance in community settings are not the same as in hospital. However, research pertaining to pressure ulcer risk management has predominantly been undertaken in hospital settings. Design The study was framed by a qualitative exploratory design. Methods Semistructured interviews were conducted with a purposive sample of 19 registered nurses recruited from an independent regional tissue viability network and five community nursing provider organisations in London. Results The experiences and perceptions of participants mapped onto the components of the Model for Examining Safety and Quality Concerns in Home HealthCare: patient characteristics, provider characteristics, nature of home healthcare tasks, social and community environment, medical devices and new technology, physical environment, and external environment. Four strategies to address identified risks were established: behavioural interventions, technical interventions, safeguarding interventions and initiatives to promote better integration between health, local authorities and families. Conclusion Understanding the complex interplay between people and other elements of the healthcare system is critical to the prevention, management and investigation of pressure ulcers. This study has illuminated these elements from the perspective of nurses working in community settings. Relevance to clinical practice Further consideration should be given to the importance of place when both developing risk management strategies for pressure ulcer prevention and learning the lessons from failure.