Wound Care and Pressure Injury Prevention in Long-Term Care: Evolving Evidence, Staffing Models, and Resident Outcomes

Abstract

This review examined the clinical, organisational, technological and policy factors that shape wound prevention and management in long-term care. Its purpose was to clarify how evolving evidence, staffing models, interdisciplinary practice and quality systems influence pressure injury development, chronic wound progression and resident outcomes. A structured narrative review approach was used, drawing on peer-reviewed studies and authoritative clinical guidance published through 2025, to synthesise international literature on pathophysiology, classification, risk assessment, early detection, preventive interventions, treatment strategies, workforce capacity, documentation, digital technologies, person-centred care, health equity and implementation policy. The evidence showed that pressure injuries arise through the interaction of mechanical loading, shear, impaired perfusion, moisture, frailty, immobility, malnutrition and multimorbidity. Effective prevention therefore depends on continuous reassessment, comprehensive skin surveillance, repositioning, pressure redistribution, continence care, nutritional support and timely clinical escalation. Findings further demonstrated that registered-nurse availability, appropriate skill mix, specialist wound leadership, continuity and interdisciplinary accountability are central to reliable care, whereas workload, turnover, burnout and missed preventive tasks increase avoidable deterioration. Digital documentation, telewound consultation and decision-support systems can improve surveillance and coordination, but their effectiveness depends on usability, data quality, staff training and governance. Resident outcomes extend beyond wound closure to include pain, mobility, sleep, dignity, psychological wellbeing, social participation and treatment burden. The review concludes that sustainable improvement requires integrated clinical, workforce and organisational reform. Long-term care providers should strengthen staffing, competency development, specialist access, resident involvement and outcome monitoring, while policymakers should align regulation, funding and reporting with resident acuity and implementation capacity. Future research should prioritise pragmatic trials, equitable assessment across skin tones, cost-effectiveness, resident-reported outcomes and context-sensitive models for resource-constrained settings.