Exploring nurses’ experiences in pressure sore care in long-term care facilities

ABSTRACT

Background

This study uses an interpretive description approach to explore nurses’ experiences with pressure sore care in long-term care facilities, highlighting the complexity of their encounters.

Methods

10 experienced nurses from South Korean small to medium-sized hospitals were chosen via purposive sampling for interviews. Data analysis utilized Braun and Clarke’s reflexive thematic analysis.

Results

The study’s findings collectively reflect the intricate journey of nurses in Long-term care facilities as they grapple with the challenges of pressure sore care. These nurses transform their perception of pressure sores, encountering a dynamic shift in their understanding. They face multifaceted challenges in providing optimal care, marked by resource constraints and the absence of standardized guidelines. Emotionally, they navigate a complex terrain of sentiments, oscillating between feelings of accomplishment and helplessness. Despite these hurdles, they persistently strive for excellence in pressure sore nursing, driven by an unwavering commitment to delivering the best possible care within the confines of their healthcare environment.

Conclusion

The study enhances understanding of pressure sore care in long-term facilities and suggests avenues for improving nursing practices and care quality through targeted interventions.

KEYWORDS:

• Pressure sore
• nurse
• experiences
• long-term care facilities
• elderly

1. Introduction

Pressure sores represent a significant healthcare challenge, particularly within long-term care facilities, where individuals with restricted mobility and chronic health conditions are predominantly situated (White-Chu et al., 2011). The global demographic shift towards an ageing population has led to the proliferation of long-term care facilities (LTCFs) aimed at catering to the needs of elderly individuals who are particularly susceptible to developing pressure sores (Anthony et al., 2019; Hayes et al., 2023). In South Korea, despite the expansion of long-term care facilities, persisting challenges impact the delivery of high-quality nursing care (Fong, 2023), thereby affecting the prevention and management of pressure sores.

Pressure sores manifest as localized injuries, primarily affecting the skin and underlying tissues in areas of bony prominence or due to friction with medical devices (Edsberg et al., 2016). These ulcers exert not only physical ramifications but also extensive consequences on patients’ overall well-being and quality of life (Kragh Nielsen et al., 2022; Roussou et al., 2023). Furthermore, pressure sores impose a substantial economic burden on healthcare systems, with annual costs ranging from 9 to 11 trillion dollars in the United States alone (William & Benjo, 2019).

Hence, the effective prevention and management of pressure sores are integral components of nursing care. Recognizing the significance of pressure sore care, professional organizations such as the American Nurses Association (ANA) and accrediting bodies like the Health Care Accreditation Council underscore its importance in assessing the quality of healthcare facilities (Duffy, 2022; Mervis & Phillips, 2019). Nurses in LTCFs play a pivotal role in providing direct patient care and implementing evidence-based practices to address pressure sores. Nevertheless, existing research suggests that these nurses encounter challenges concerning knowledge and performance when compared to their counterparts in tertiary hospitals (Beeckman et al., 2011; Horn et al., 2010). These challenges may be attributed to factors such as limited resources and inadequate education (Christine et al., 2016).

A gap exists in qualitative research that delves into the lived experiences of nurses engaged in pressure sore care. Quantitative studies, while valuable, often fall short in capturing the nuanced and contextual dimensions of nurses’ experiences in this domain. Qualitative research methods, such as interviews and observations, provide a deeper insight into the unique challenges, ethical dilemmas, and strategies employed by long-term facility nurses (Cypress, 2018). Through qualitative research, a comprehensive understanding can be gained of the obstacles they encounter and the strategies they employ to provide optimal care. This knowledge can then be employed to inform targeted interventions and enhance pressure sore management practices within long-term care settings. Qualitative inquiry equips us with valuable insights that quantitative assessments alone cannot provide (Gaber, 2020), thus addressing the limitations of prior studies and advancing our comprehension of nursing care on pressure sores within long-term care facilities.

Despite the proliferation of long-term care facilities, the delivery of high-quality nursing care concerning pressure sore prevention and management remains a formidable challenge. To bridge this knowledge gap, the present study adopts an interpretive description approach to investigate the firsthand experiences of long-term facility nurses in the realm of pressure sore care, with a specific focus on the Korean context. By delving deep into the intricacies and contextual elements that shape their experiences, this research endeavours to generate comprehensive insights that can inform evidence-based approaches for enhancing nursing practice and ultimately elevating patient outcomes.

2. Methodology

2.1. Purpose

This research aims to uncover the complexities and challenges encountered by nurses in the management of pressure sores in long-term care settings. Through this approach, a deeper understanding of the topic can be achieved, providing valuable insights for healthcare professionals and informing the development of effective interventions and strategies.

2.2. Design

The interpretive description approach was chosen for its ability to capture the complexity and nuances of the nurses’ experiences in pressure sore care. This qualitative research method allows for a flexible and iterative approach to data collection and analysis, ensuring a comprehensive exploration of the phenomenon (Chiu et al., 2022; Lee & Thorne, 2022).

2.3. Sample/Participants

This study involved 10 registered nurses with a background in pressure sore care from 4 LTCFs in South Korea. We selected facilities with a bed capacity of fewer than 500, excluding private hospitals. The participants comprised nurses with over one year of clinical experience, excluding nurse managers. To recruit participants, we employed a snowball sampling technique, wherein initial participants recommended other nurses with substantial experience in pressure sore care. The general characteristics of the study participants are shown in Table I. The group included 3 males and 7 females, with ages ranging from 26 to 44 years (average age 32.1 years). Their total clinical experience varied from 1 to 18 years, averaging 5.6 years. Among them, 8 were working in medical wards, 1 in a surgical ward, and 1 in an emergency room.

Table I. Characteristics of participants (N = 10).

No	Sex	Age (years)	Working Period (years)	Working Place	Unit
1	Male	34	5	D hospital	General Ward
2	Male	38	7	D hospital	Surgical Part
3	Male	36	8	D hospital	General Ward
4	Female	44	18	D hospital	General Ward
5	Female	26	1	D hospital	General Ward
6	Female	30	6	D hospital	Emergency Ward
7	Female	27	2	D hospital	General Ward
8	Female	29	4	H hospital	General Ward
9	Female	27	2	W hospital	General Ward
10	Female	30	3	E hospital	General Ward

2.4. Data collection

Data collection for this study occurred from January 1 to 31 March 2021, involving in-depth, one-on-one interviews with 10 research participants from four hospitals with LTCFs in South Korea. Each participant provided written consent for their involvement. Due to the COVID-19 situation, interviews were conducted in two formats to ensure the safety of both participants and the research team while accommodating the constraints of the pandemic. Specifically, 7 interviews were carried out face-to-face in the institution’s break rooms, with all necessary safety measures such as mask-wearing and social distancing diligently observed. Additionally, 3 interviews were conducted via telephone calls. This approach was adopted primarily to mitigate the risks associated with in-person interactions during the pandemic. Despite the differences in interview formats, we made concerted efforts to maintain consistency in engagement and data quality across both methods. Also, all interviews in our study were audio-recorded, and we obtained explicit consent from each participant for this before the interviews commenced.

Before data collection commenced, the research team engaged in a detailed preliminary review to refine the interview questions, ensuring a collaborative approach where each member’s expertise significantly shaped the development process. This crucial phase was led by the first researcher, a male nurse with a rich background in the field. His contributions went beyond merely drafting the questionnaire; as the interviewer, he infused the questions with practical insights and relevance, drawing from his extensive real-world nursing experiences. The refinement phase was marked by the active involvement of the remaining team members, who brought their specialized knowledge to the table, thereby enriching the questionnaire’s scope and depth. A qualitative researcher, with expertise in mental health nursing, offered essential insights into the intricacies of mental health care, ensuring the questionnaire comprehensively covered these critical aspects. Concurrently, a general nursing professor provided a wider educational and practice-oriented perspective, which was instrumental in broadening the questionnaire’s relevance across diverse nursing practices. The contributions from each team member ensured that the interview questions were comprehensive, relevant, and aligned with the goals of the study. Following this collaborative refinement, the finalized interview framework was applied in the data collection phase of the research.

The interviewer, also the primary researcher of this study, brought a robust background to the qualitative research. His experience included five years in an intensive care unit and another five years as a Wound Ostomy Continence Nurse (WOCN), alongside extensive engagement in wound care societies and education. Academically, he was furthering his expertise through a doctoral programme in nursing, emphasizing qualitative research methods, and was mentored by a professor specializing in this area. To prepare for this study, he conducted an extensive literature review, encompassing relevant papers and books, to deepen his understanding of qualitative research. His research was carried out under the guidance of a professor expert in qualitative methods, ensuring a methodologically sound and well-informed approach. This blend of practical experience and academic rigour was pivotal not only in shaping the research approach but also in fostering a meaningful rapport with participants. Notably, the interviewer had no prior direct working relationships with any of the nurse participants involved in the study. This absence of pre-existing professional connections ensured that interactions during the interviews remained unbiased and focused solely on the research objectives.

Before initiating the interviews, rapport was established with the participants through non-personal, casual conversations. This was followed by detailed explanations about the study’s purpose, procedures, and ethical considerations, ensuring that the participants were well-informed and comfortable with the process. The data collection consisted of semi-structured interviews with each participant, conducted over 2 to 3 sessions. Each interview lasted between 60 to 90 minutes. In the case of the face-to-face interviews, a single meeting was sufficient to gather an exhaustive range of data from each of the seven participants. The direct, in-person dynamics facilitated an efficient and effective exchange of questions and responses, enabling a rich compilation of qualitative data within the allocated timeframe. Conversely, the telephone interviews, undertaken with three participants, required a distinct approach due to the inherent limitations of telephonic communication. Notably, the lack of visual cues and the potential for verbal misunderstandings demanded additional time and attention. To counter these challenges and to ensure the clarity and depth of the collected data, it was decided that two interviews would be conducted for each participant in this format. This methodological adjustment allowed for more deliberate and focused interactions, capturing the nuances of the participants’ experiences with greater accuracy. The concluding phase of the interview process, whether it was the second for face-to-face or the third for telephone interviews, was devoted to the meticulous validation of the collected data. During this phase, particular responses that necessitated further exploration were revisited, ensuring the integrity and completeness of the research findings. The interview sequence was initiated with a broad query: “Please share your experiences with pressure sore care in small- to medium-sized hospitals.” Subsequent questions in these interviews encouraged the participants to provide more detailed explanations and express their emotional responses related to pressure sore care. This approach allowed for a comprehensive exploration of their personal experiences and perspectives regarding pressure sore care in these healthcare settings. The semi-structured interview questions have been included as supplementary material (see Supplementary File 1).

In qualitative research, data collection is essential to establish an adequate and information-rich sample that provides coherent stories (Malterud, 2012). Accordingly, by conducting interviews with 10 nurses, this research successfully captured well-structured narratives, providing deep insights into the intricate details and varied experiences related to managing pressure sores in long-term care facilities.

2.5. Data analysis

The data collected in this study underwent a rigorous analysis process to develop a rich understanding of the experiences and challenges faced by nurses in long-term care facilities. This process commenced with the initial data processing, which was managed using Google Speech-to-Text software. This tool was instrumental in converting the audio recordings of interviews into text format, thereby facilitating the subsequent steps of analysis. The transcribed content was then meticulously typed and securely stored in Microsoft Word documents, with the data well-organized and easily accessible for further examination. To ensure confidentiality, participants’ personal information was encrypted and separately stored in an Excel spreadsheet.

Following this preparatory phase, we engaged in a comprehensive thematic analysis, adhering to the 6 steps of Braun and Clarke’s reflexive thematic analysis method (Braun & Clarke, 2021). Thematic analysis involves systematically identifying, analysing, and interpreting patterns or themes within the data to comprehensively understand the phenomenon under investigation. (1) Following the data collection phase, we familiarized ourselves with the data by reading and rereading the transcripts of the interviews with long-term facility nurses. (2) we then generated initial codes, which involved labelling and categorizing different aspects of the data related to pressure sore care experiences. (3) These codes were subsequently organized into potential themes, which captured meaningful patterns or recurring topics in the data. (4) The researchers reviewed and refined the themes by collating relevant codes, comparing them, and considering their coherence and relevance to the research questions. (5) We also conducted multiple iterations of the analysis, ensuring the themes adequately represented the data and reflected the participants’ experiences. (6) The final step involved defining and naming the themes and creating a coherent and comprehensive framework for understanding the pressure sore care experiences of long-term facility nurses.

Additionally, data coding, a pivotal step in enhancing reliability and reducing potential bias in data interpretation, was conducted by two trained coders under the researchers’ supervision. For the statistical analysis, including the calculation of averages, we utilized the data stored in these formats. This study follows the consolidated criteria for reporting qualitative research (COREQ) checklist (Tong et al., 2007; see Supplementary File 2).

2.6. Ethical consideration

This study was conducted in strict adherence to ethical standards, following the Declaration of Helsinki, and prioritized the rights and well-being of participants. It received approval from the Institutional Review Board (IRB) of C University, as evidenced by IRB number 1,040,198–200619-HR-066-01. Participants were contacted through phone and email, and they received comprehensive explanations about the study. Informed consent was obtained from all participants after providing them with a detailed understanding of the study’s objectives, procedures, and potential risks and benefits. Participants were assured that their involvement in the study was voluntary and that their confidentiality and anonymity would be rigorously protected. To minimize any potential harm or distress, several precautions were implemented. These included informing participants about the nature of the study and its potential emotional impacts upfront. Furthermore, during the interviews, a supportive and empathetic approach was consistently maintained to address and manage any emotional reactions that the participants might experience. Additionally, participants were reminded of their freedom to withdraw from the study at any point, ensuring that their participation remained within their comfort levels.

They were made aware of the recording of their interviews and assured of the confidentiality and anonymity of their responses. To acknowledge their valuable time and effort, each participant received a KRW20,000 gift voucher, awarded unconditionally to emphasize our ethical commitment, regardless of interview completion status.

2.7. Rigor

To enhance credibility and trustworthiness, this study adhered to Sandelowski’s (1993) elements of rigour. We immersed ourselves in the data, validating participants’ statements through member checking and potentially employing data triangulation. To address transferability, a clear description of the research context and participants, along with detailed experiential descriptions, was provided. Dependability was ensured through transparent documentation and the potential creation of an audit trail. Confirmability was achieved by mitigating researcher bias through self-reflection and seeking independent perspectives through peer debriefing or external review.

3. Results

Based on the analysis of data following Braun and Clarke’s reflexive thematic analysis method, the findings revealed four main themes and nine subthemes in the context of pressure sore care (Table II).

Table II. Themes and subthemes.

Theme	Subtheme
Change in Perception of Pressure Sores	Nurses’ awareness of pressure sores in elderly patients
	Reduced sensitivity due to prolonged hospitalization
Challenges in Providing Adequate Care for Patients with Pressure Sores	Insufficient personnel in long-term care facilities
	Struggles in overcoming the lack of guidelines in pressure sore care
Nurses’ Ambivalent Emotions in Pressure Sore Nursing	Guilt and resentment
	Accomplishment and helplessness
Striving for Optimal Pressure Sore Nursing in a Constrained Environment	Communication with administrators
	Interest and responsibility despite challenges

3.1. Change in perception of pressure sores

This theme explores the shift in how individuals, particularly healthcare professionals, perceive pressure sores. It delves into the evolving awareness and understanding of the significance of pressure sores, particularly in the context of elderly patients or those with prolonged hospitalization. This theme investigates the transformation of attitudes and perspectives towards pressure sores within the healthcare setting.

3.1.1. Nurses’ awareness of pressure sores in elderly patients

Nurses consistently encounter patients with pressure sores and recognize the demanding nature of pressure sore nursing care. They prioritize pressure sore management due to the high prevalence among elderly, malnourished patients prone to friction and moisture-related issues. Additionally, nurses note that patients admitted to the Long-term facility primarily suffer from neurological disorders, increasing their vulnerability to pressure sore development compared to the general patient population.

During my tenure at the current facility, I consistently encounter patients who suffer from pressure sores. The demanding nature of pressure sore nursing care is seemingly boundless. Consequently, I place utmost importance on pressure sore management while attending this Long-term facility. Considering that the majority of patients are elderly, malnourished, and prone to issues related to friction and moisture, the significance of addressing pressure sores becomes evident (Participant 4).

Most patients admitted to the Long-term facility have been classified under the long-term care rating. This indicates that the patients primarily suffer from specific conditions such as dementia, Parkinson’s disease, or other neurological disorders, resulting in complete or partial paralysis. As a result, the likelihood of pressure sore development is significantly higher among these individuals in comparison to the general patient population (Participant 7).

It can be said that pressure sore care is the pinnacle of nursing in Long-term facilities (Participant 10).

3.1.2. Reduced sensitivity due to prolonged hospitalization

Nurses’ experiences revealed that patients often faced recurrent or worsening pressure sores upon readmission, leading to frustration. The nurses acknowledged their reliance on mechanical approaches and insufficient attentiveness to ulcer care, emphasizing the need for improved practices.

When the hospitalization of elderly patients is prolonged, families often find themselves unable to cope with the increasing medical expenses. Consequently, patients are transferred to other nursing care centers where public long-term care insurance is applicable. In cases where patients show improvement in pressure sores and are discharged to another long-term facility, they often develop new pressure sores in different areas, or their existing pressure sores worsen upon return. It is rare for them to come back in an improved condition. It can be quite disheartening when we have treated them well and sent them off, only to see their condition deteriorate upon their return. Now, I feel like thinking, ‘No matter how diligently we treat the ulcers, they will just worsen again anyway, so let’s just provide general care.’ (Participant 2).

Looking back at the pressure sore care I have provided, it feels like I did it mechanically. I would just check it off on the paperwork without actually examining the ulcer. Only when the dressing was oozing would I finally change it. When pressure sore patients are admitted, I find myself thinking, ‘Oh, they’re back again?’ For patients who need immediate surgery, I realize I need to be more attentive and focused, but for pressure sore patients, their condition doesn’t deteriorate dramatically, does it? (Participant 5).

3.2. Challenges in providing adequate care for patients with pressure sores

In this theme, the focus is on the obstacles and difficulties faced in delivering effective care for pressure sores. It addresses issues related to staffing shortages, the absence of nursing guidelines, and inadequacies in educational programmes within long-term care facilities. This theme aims to provide a comprehensive understanding of the challenges that healthcare professionals encounter when striving to prevent and manage pressure sores.

3.2.1. Insufficient personnel in long-term care facilities

Understaffing in nursing care creates challenges such as difficulty in performing essential tasks like repositioning and inadequate examination of high-risk patients for pressure sore development, leading to personal hardships, frustration, and reduced time for direct patient care. Participants envy better-staffed acute facilities, highlighting the negative impact of understaffing on the quality and efficiency of nursing care in long-term facilities.

I have mentioned the issue of understaffing to nursing managers and administrators. Due to the lack of nursing personnel, it becomes challenging to perform tasks such as repositioning every two hours. We have been discussing the need for additional staff for almost a year, but nothing has changed. Even the nursing managers themselves are overwhelmed. Increasing the workforce requires approval from the hospital director or board members, and they probably deem it financially difficult. Eventually, I gave up. I just endured and worked, but there were many days when I couldn’t even eat because of the shortage of staff and the workload. Honestly, I couldn’t properly examine high-risk patients for pressure sore development, no matter how busy I was running around (Participant 9).

When sterilizing the dressing sets for pressure sores, the nurses working on the ward have to go and do it themselves. In acute facilities, there are separate nurses responsible for sterilization. However, in our case, while working on the ward, if we have to sterilize, we nurses have to go to the sterilization room, operate the autoclave, and then return. As a result, the time available for patient care on the ward is reduced. Acute facilities have better staff allocation and specialization, and I envy that aspect (Participant 6).

3.2.2. Struggles in overcoming the lack of guidelines in pressure sore care

The subtheme that emerges from this study is the participants’ struggle due to the absence of comprehensive and up-to-date guidelines or resources for pressure sore care in nursing. They describe relying on internet searches and often feeling ill-prepared when tasked with assessing pressure sore stages. Additionally, they frequently encounter outdated information, casting doubts on its relevance and applicability.

This overarching theme encompasses the challenges and limitations related to education and resources for pressure sore care within long-term facilities. The participants’ experiences highlight their dependence on informal learning methods and the necessity for self-directed learning. All of this occurs within the context of limited access to formal education and resources for pressure sore care, emphasizing the need for alternative means of knowledge acquisition, such as seeking guidance from colleagues and conducting internet searches.

I had not encountered any prior guidelines or literature pertaining to pressure sore nursing care. However, upon encountering pressure sores for the first time when starting my position, I conducted an internet search on a major online platform, Naver (referred to as the ‘Google of South Korea’). This was necessary as I had to personally document the stages of pressure sores. I vividly recall a moment of anxiety when a senior nurse asked me to assess the stage of a pressure sore for a newly admitted patient. The symptom appeared to be between stage 3 and 4, but upon actual examination, it became exceedingly perplexing (Participant 1).

I came across guidelines addressing pressure sores, albeit in conjunction with other nursing procedures. The section dedicated to pressure sores spanned merely one or two pages, and notably featured outdated content. Upon scrutiny, I realized that the information provided predates what I had learned during my academic years (Participant 8).

In the context of long-term facilities, it is practically challenging to conduct formal and structured education specifically focused on pressure sore care. Instead, individuals in these settings rely on informal learning methods and seek guidance from fellow nurses when they have questions or uncertainties about pressure sores. (Participant 9).

3.3. Nurses’ ambivalent emotions in pressure sore nursing

This theme delves into the emotional experiences of nurses involved in pressure sore care. It highlights the mixed emotions, including feelings of guilt and resentment, alongside sentiments of accomplishment and helplessness, that nurses may grapple with when providing care to patients with pressure sores. It seeks to comprehend the emotional complexities that nurses face in this specific area of nursing.

3.3.1. Guilt and resentment

Nurses experience a profound sense of guilt and introspection when confronted with a worsening pressure sore despite their dedicated efforts. The discrepancy between their expectations and the actual outcome triggers self-doubt and frustration, fuelling an internal struggle to identify potential missteps or alternative approaches. Compounding their emotional burden, nurses may face resentment from caregivers who assign blame for the pressure sore’s occurrence, creating an unwarranted sense of responsibility and necessitating apologies, even though they genuinely believe their actions were not primarily at fault.

I continuously dressed a patient’s pressure sore for a month, but instead of improving, it progressively worsened. Thoughts such as ‘I have been diligently dressing it, so why is it getting bigger?’ crossed my mind. I also questioned whether I had done something wrong or if there were more effective methods. Witnessing the deterioration of the pressure sore despite my direct involvement in the dressing process left me feeling distressed and unsure of how to proceed (Participant 7).

I have had an experience where I clashed with a patient’s caregiver regarding pressure sores. The caregiver was a nurse who happened to be a family member of the patient. However, the patient developed a pressure sore, which caused the caregiver to become angry and question why it occurred and how it happened, raising their voice. Despite diligently performing repositioning and applying preventive dressings, the patient’s condition did not improve, and the caregiver continued to scrutinize. In the end, I had to apologize, even though it seemed like we had not made any significant mistakes (Participant 10).

3.3.2. Accomplishment and helplessness

A sense of accomplishment arises when nurses witness the healing of a patient’s pressure sore, providing them with a feeling of fulfilment and pride in their work. This theme highlights the positive impact of their efforts and the satisfaction derived from effectively managing and improving the condition. On the other hand, the experience of helplessness emerges when pressure sores progress to more severe stages despite the nurses’ diligent care. This theme reflects the frustration and sense of being overwhelmed that nurses may experience when faced with the limitations of their interventions and the challenges associated with managing advanced pressure sores. Overall, the combination of accomplishment and helplessness provides a nuanced portrayal of the nurse’s experience in pressure sore care, encompassing both positive and challenging aspects of their role.

One positive aspect is witnessing the healing of a patient’s pressure sore firsthand, which elicits a sense of pride and accomplishment. The satisfaction of effectively managing and healing the pressure sore, leading to the joy of both the patient and their caregiver, represents the greatest fulfillment for nurses. Moreover, the healing of pressure sores can be seen as a reduction in nursing workload in a way, as it signifies a positive outcome in terms of wound management (Participant 7).

In the early stages where pressure sores are superficial, nurses provide extensive care to prevent further deterioration. However, as the condition progresses to necrosis and requires debridement, or becomes chronic, there comes a point where nurses feel compelled to give up. Physicians may even request nurses to focus solely on repositioning and dressing changes without further assessment. Caregivers, too, may reach a point of resignation and request to prevent further worsening (Participant 9).

3.4. Striving for optimal pressure sore nursing in a constrained environment

This theme investigates the efforts made by healthcare professionals, particularly nurses, to provide the best possible care for pressure sores within the limitations of their working environment. It includes aspects such as communication with administrators and the ongoing interest and sense of responsibility of nurses.

3.4.1. Communication with administrators

Nurses in LTCFs experienced a strong emphasis on pressure sore care due to the active involvement and interest of the facility director. The director’s direct engagement in debridement and dressings, regular reporting of pressure sore cases, and introduction of new wound dressing products created a sense of importance and urgency surrounding pressure sore management. Additionally, nurses had the opportunity to participate in nursing management meetings where pressure sores were a key topic, highlighting the significance placed on preventing and addressing these wounds.

In the long-term facility where I worked, the emphasis on pressure sore care was primarily driven by the strong interest of the overall supervisor, specifically the facility director. The director demonstrated a keen interest in pressure sores by frequently engaging in activities such as performing debridement and dressings. They also sought regular reports on pressure sores and frequently invited pharmaceutical company representatives to introduce new products related to wound dressings, leading to a substantial adoption of these products (Participant 6).

I had the opportunity to attend several nursing management meetings, where the main focus was on topics such as pressure sores, falls, and infections. Among them, pressure sores were considered the most important. Nursing supervisors paid particular attention to the ward with the highest incidence of pressure sores, and these incidents were reported during the meetings, highlighting the significance placed on preventing and managing pressure sores (Participant 8).

3.4.2. Interest and responsibility despite challenges

The nurses demonstrate a strong interest in preventing pressure sores and feel a sense of responsibility towards their patients’ well-being, even in the face of difficulties and physical challenges. They maintain their commitment and invest effort in providing quality care, recognizing the importance of their role in preventing and managing pressure sores.

In our long-term facility, there is a prevailing mindset that emphasizes unwavering attention to the occurrence of pressure sores in patients. Nurses consider pressure sores to be solely their responsibility, rather than that of doctors, caregivers, or administrators, fostering a culture of accountability and a strong sense of duty (Participant 8).

The act of repositioning patients, which takes only 1–2 minutes, has a significant impact on their well-being. Despite the physical strain it may cause, nurses recognize it as a fundamental aspect of nursing care, empathizing with the discomfort patients would experience if they were in the same position for over two hours, and they believe that their efforts yield noticeable improvements over time (Participant 9).

4. Discussion

This study has conducted a comprehensive analysis, uncovering 4 major themes and 8 subthemes, which provide profound insights into nurses’ experiences working in LTCFs regarding pressure sore management.

In this study, the challenges faced by nurses in LTCFs concerning pressure sore care are multi-faceted and encompass various aspects. Novice nurses often experience bewilderment when dealing with pressure sores, highlighting the urgent need for improved, specialized education and training specific to pressure sore care within nursing colleges. Given the higher prevalence and severity of pressure sores in LTCFs compared to other healthcare settings, there is a compelling case for the development and enhancement of educational programmes related to pressure sores at the university level (Horn et al., 2010; Jump et al., 2018). This can better prepare nurses for their roles in LTCFs, reducing the bewilderment they experience due to the vital seriousness of pressure sores and their relative lack of knowledge (Cremasco et al., 2012; Demarré et al., 2015).

Furthermore, the issue of desensitization among LTCF nurses due to the chronic nature of pressure sores is a matter of concern. Nurses tend to become desensitized to these chronic wounds due to prolonged patient stays and frequent patient circulation between LTCFs (Bruke et al., 2016). This cycle leads to lapses in proper assessment and care. Addressing this issue necessitates ongoing education and reinforcement of best practices, along with interventions to maintain nurses’ sensitivity to pressure sores and the need for continuous high-quality care (Kim & Lee, 2019).

The perception that pressure sores are not a priority compared to other chronic health conditions in LTCFs indicates a need for a shift in awareness and priorities. While patients may initially be admitted for acute conditions, these conditions often transition to chronic states over time, leading to prolonged stays in LTCFs. Consequently, the recognition of pressure sores as a critical nursing concern tends to diminish (Bruke et al., 2016). This perception gap calls for educational and awareness campaigns to emphasize the severity of pressure sores, their potential life-threatening implications, and the significant impact they have on patients’ well-being and quality of life. This change in perception will promote the prioritization of pressure sore care in LTCFs and improve patient outcomes (Sving et al., 2012).

Furthermore, the challenging environment within LTCFs, characterized by limited resources and insufficient specialized personnel, places significant burdens on nurses responsible for pressure sore care. The scarcity of essential wound care products and specialized wound, ostomy, and continence nurses (WOCNs) represents a substantial hurdle (Christine et al., 2016; Horn et al., 2010). Most of the pressure sore care is performed by regular registered nurses, and studies have shown deficiencies in their knowledge and execution of pressure sore care (Kim & Lee, 2019). To address this, national healthcare systems should allocate substantial economic support for pressure sore management, ensuring the availability of diverse and effective products, as well as bolstering the workforce with adequately trained personnel. Adequate support and resources are paramount in addressing these environmental challenges.

Lastly, the importance of education is underscored in improving pressure sore care. Education on pressure sore care during nursing programmes at the university plays a crucial role in shaping nurses’ clinical practice. However, there is currently a deficiency in pressure sore education at this stage, which requires attention and improvement (Alshahrani et al., 2023; Larimi et al., 2023). Also, it is essential to develop programmes tailored to LTCF nurses’ specific needs, focusing on hands-on training led by specialized professionals like WOCNs, who can provide concentrated, practical education in a short period (Stephens et al., 2023). This approach can bridge the knowledge and performance gap, ensuring that LTCF nurses are well-prepared to handle pressure sores effectively.

These challenges reveal that addressing pressure sores within LTCFs is a complex task that requires comprehensive solutions. Improving education, increasing awareness, and providing substantial support for LTCFs are fundamental steps in enhancing the care provided for pressure sores. Additionally, hands-on training by specialized professionals is integral to equipping nurses with the skills and confidence needed to deliver high-quality pressure sore care effectively. By addressing these core issues, nurses can navigate the complexities of pressure sore care more effectively, ultimately improving patient outcomes and their overall quality of life.

Recognizing and addressing these challenges will enable South Korea to improve the quality of nursing care in long-term care facilities, enhance pressure sore prevention and management practices, and ultimately improve the well-being and outcomes of residents in these settings.

This study’s limitations include the challenges posed by the pandemic, notably the difficulty in perceiving participants’ facial expressions during in-person interviews due to mask-wearing. This could have impacted the depth of understanding of their emotions and responses. Additionally, pandemic-related constraints might have affected the richness of the data collected. Furthermore, the sample size and geographical focus, being specific to healthcare professionals in long-term care facilities, may limit the breadth of perspectives on pressure sore care. This specificity could affect the generalizability of the findings to other regions or populations. Future research, potentially involving a more diverse participant pool and broader geographical coverage, could yield a more comprehensive understanding of the challenges and strategies related to pressure sore care in various settings.

5. Conclusion

This interpretive description study seeks to contribute to the existing literature on pressure sore care by providing a comprehensive understanding of the experiences of long-term facility nurses. The insights gained from this research will inform evidence-based strategies and interventions aimed at enhancing the quality of care provided in the context of pressure sore prevention and management. By addressing the unique challenges faced by long-term facility nurses, this study aims to improve patient outcomes and contribute to the advancement of nursing practice in the care of individuals with pressure sores in long-term care settings.

Author contributions

Each author has made substantial contributions to this study, including conception, study design, data acquisition, analysis, interpretation, drafting, critical review, final approval of the manuscript for publication, and selection of the target journal. All authors agree to be accountable for all aspects of the work.

Data sharing statement

The datasets utilized in this study can be made available upon reasonable request from the corresponding author.

Ethics approval and participant consent

This research received ethical approval from the Institutional Review Board of Chonnam National University (1040198–200619-HR-066-01), adhering to ethical standards in accordance with the Declaration of Helsinki, and informed consent was duly obtained from all study participants.

Acknowledgments

The authors express their sincere gratitude to all the participants for their cooperation in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17482631.2024.2324495.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.

Notes on contributors

Hyung-Ju Na

Hyung-Ju Na is a registered nurse affiliated with the Ministry of Health and Welfare of Korea. He currently works as a Wound, Ostomy, and Continence-Nursing Specialist at Seoul Metropolitan Dongbu Hospital. He holds a Ph.D. from Chonnam National University. His primary research interests revolve around improving nursing services for elderly patients and pressure ulcer patients in small to medium-sized hospitals.

Sung-Hee Yoo

Sung-Hee Yoo is a registered nurse affiliated with the Ministry of Health and Welfare of Korea. She obtained her Ph.D. from Yonsei University and previously worked at Asan Medical Center. Currently, she holds the position of a professor in adult nursing at Chonnam National University’s College of Nursing. Her primary research focus is on enhancing the quality of life for stroke patients.

Young-Ran Kweon

Young-Ran Kweon is a registered nurse affiliated with the Ministry of Health and Welfare of Korea. She holds the position of a professor in psychiatric mental health nursing at Chonnam National University’s College of Nursing. She serves as the Director of the Gwangju Dong-gu Community Addiction Management Center in her capacity as a Psychiatric Mental Health Nurse Practitioner (PMHNP). Her research interests primarily revolve around utilizing qualitative methods to comprehend individuals’ experiences related to distress and recovery.