It's a 'tick and flick' checklist: How nurses experience pressure injury risk assessment and care planning in hospitals - A qualitative study.

Aim

To explore nurses' experiences, perceptions, and decision-making processes in pressure injury risk assessment and care planning in acute hospital settings, including barriers and facilitators, to inform the development of more integrated, workflow-aligned, and patient-centred documentation systems.

Materials And Methods

This study employed a qualitative descriptive design. Purposive sampling captured nursing staff directly involved in pressure injury prevention practices. In-person focus groups were conducted between 9 April 2025 and 22 September 2025 following a semi-structured question guide. Transcripts were thematically analysed. Participants also completed demographic and self-reported knowledge questionnaires.

Findings

Three themes were identified that captured the experiences of nurses providing pressure injury prevention in acute hospital settings: "expected practice versus reality", "the disconnect between identifying risk and providing care", "the mismatch between documentation and clinical workflows. Nurses frequently relied on their clinical judgement to guide care, particularly when documentation requirements were perceived as low-value or fragmented.

Conclusion

This study identified that current risk assessment and care planning processes are time-consuming, repetitive, and poorly aligned with clinicians' workflows, often resulting in reliance on clinical judgement over standardised documentation. Fragmented forms and electronic systems, combined with workflow pressures, limited the usefulness of risk assessments in guiding patient-specific care. Findings support streamlined, integrated electronic medical record (eMR) workflows that reduce documentation burden, provide actionable guidance, and directly link risk identification with preventative interventions.