Barriers and facilitators for caregiver involvement in the home care of people with pressure injuries: A qualitative study

Autoři: Francisco José García-Sánchez aff001;  Vicente Martínez-Vizcaíno aff002;  Beatriz Rodríguez-Martín aff002
Působiště autorů: University of Castilla-La Mancha, Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, Ciudad Real, Spain aff001;  University of Castilla-La Mancha, Health and Social Research Center, Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Cuenca, Spain aff002;  Universidad Autónoma de Chile, Faculty of Health Sciences, Santiago, Chile aff003;  University of Castilla-La Mancha, Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, Talavera de la Reina, Toledo, Spain aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226359



To explore the barriers and facilitators perceived by home caregivers regarding their involvement in the home care of people with pressure injuries.


Although home caregivers are key in the process of caring for people with pressure injuries, little is known about their perceptions regarding their involvement in the same.


A qualitative study based on grounded theory involving a theoretical sample of 15 home caregivers of people with pressure injuries within the health district of Puertollano, Spain.


This study identified three barriers (feminization of care, necessary life adaptations as a home caregiver, and the organization of health services) and three facilitators (the perceived family duty for caring, willingness to provide care, and satisfaction with the care received on behalf of primary care services) associated with caregiver involvement in the home care of pressure injuries.


The care of a person with pressure injuries is perceived as a duty and requires important adaptations affecting the home caregiver’s personal, social and work life. The emotional closeness and trust that develops between a patient and the primary care staff equals an involvement which, in turn, also has positive results for both the home caregiver and the patient.

Klíčová slova:

Coding theory – Decision making – Human families – Long-term care – Nurses – Primary care – Qualitative studies – Spain


1. Shi C, Dumville JC, Cullum N. Skin status for predicting pressure ulcer development: A systematic review and meta-analyses. Int J Nurs Stud. 2018;87: 14–25. doi: 10.1016/j.ijnurstu.2018.07.003 30015089

2. National Pressure Ulcer Advisory Panel EPUAP and PPPIA (NPUAP/EPUAP/PPPIA). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler, editor. Osborne Park, Western Australia: Cambridge Media; 2014.

3. Pancorbo-Hidalgo PL, García-Fernández FP, Torra i Bou J-E, Verdú Soriano J, Soldevilla-Agreda JJ. Epidemiology of pressure ulcers in Spain in 2013: 4th National Study on Prevalence. Gerokomos. 2014;25: 162–170. doi: 10.4321/S1134-928X2014000400006

4. Barrois B, Colin D, Allaert F-A. Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France. Hosp Pract. 2017; 1–7. doi: 10.1080/21548331.2018.1418139 29241381

5. Børsting TE, Tvedt CR, Skogestad IJ, Granheim TI, Gay CL, Lerdal A. Prevalence of pressure ulcer and associated risk factors in middle and older age medical inpatients in Norway. J Clin Nurs. 2017; 1–9. doi: 10.1111/jocn.14088 28960642

6. Vanderwee K, Clark M, Dealey C. Pressure ulcer prevalence in Europe: a pilot study. J Eval. 2007;13: 227–235.

7. Hurd T, Posnett J. Point prevalence of wounds in a sample of acute hospitals in Canada. Int Wound J. 2009;6: 287–293. doi: 10.1111/j.1742-481X.2009.00615.x 19719525

8. da Silva Cardoso JR, Blanes L, Augusto Calil J, Ferreira Chacon JM, Masako Ferreira L. Prevalence of pressure ulcers in a Brazilian hospital: results of a cross-sectional study. Ostomy Wound Manag. 2010;56: 52–57.

9. García-Sánchez FJ, Martínez-Vizcaíno V, Rodríguez-Martín B. Conceptualisations on home care for pressure ulcers in Spain: perspectives of patients and their caregivers. Scand J Caring Sci. 2019;33: 592–599. doi: 10.1111/scs.12652 30735262

10. Artico M, Dante A, D ‘angelo D, Lamarca L, Mastroianni C, Petitti T, et al. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review. Palliat Med. 2018;32: 299–307. doi: 10.1177/0269216317737671 29130416

11. García Alcaraz F, Delicado Useros V, Alfaro Espín A, López-Torres Hidalgo J. Use of sociosanitary resources and characteristics of the informal care of immobilized patients receiving home care. Atención Primaria. 2015;47: 195–204.

12. Mausbach BT, Coon DW, Depp C, Rabinowitz YG, Wilson-Arias E, Kraemer HC, et al. Ethnicity and Time to Institutionalization of Dementia Patients: A Comparison of Latina and Caucasian Female Family Caregivers. J Am Geriatr Soc. 2004;52: 1077–1084. doi: 10.1111/j.1532-5415.2004.52306.x 15209644

13. Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: Hospital inpatient perspectives. J Adv Nurs. 2007;57: 494–504. doi: 10.1111/j.1365-2648.2006.04140.x 17284276

14. Latimer S, Chaboyer W. Patient participation in pressure injury prevention: giving patient’s a voice. Scand J Caring Sci. 2014;28: 648–656. doi: 10.1111/scs.12088 24117711

15. Gorecki C, Nixon J, Madill A, Firth J, Brown JM. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors. J Tissue Viability. 2012;21: 3–12. doi: 10.1016/j.jtv.2011.11.001 22137874

16. Gorecki C, Closs SJ, Nixon J, Briggs M. Patient-reported pressure ulcer pain: A mixed-methods systematic review. J Pain Symptom Manage. 2011;42: 443–459. doi: 10.1016/j.jpainsymman.2010.11.016 21444182

17. Beitz JM, Goldberg E. The Lived Experience of Having A Chronic Wound: A Phenomenologic Study. MEDSURG Nurs. 2005;14: 51–82. 15779741

18. Roberts S, McInnes E, Wallis M, Bucknall T, Banks M, Chaboyer W. Nurses’ perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nurs. 2016;15: 64. doi: 10.1186/s12912-016-0188-9 27895528

19. Chaboyer W, Gillespie BM. Understanding nurses’ views on a pressure ulcer prevention care bundle: a first step towards successful implementation. J Clin Nurs. 2014;23: 3415–3423. doi: 10.1111/jocn.12587 24646406

20. Bernardes A, G. Cummings G, Gabriel CS, Martinez Évora YD, Gomes Maziero V, Coleman-Miller G. Implementation of a participatory management model: analysis from a political perspective. J Nurs Manag. 2015;23: 888–897. doi: 10.1111/jonm.12232 24862294

21. Baharestani MM. The lived experience of wives caring for their frail, homebound, elderly husbands with pressure ulcers. Adv Wound Care. 1994;7: 40–2, 44–6, 50 passim.

22. Sebern MD. Explication of the construct of shared care and the prevention of pressure ulcers in home health care. Res Nurs Health. 1996;19: 183–192. doi: 10.1002/(SICI)1098-240X(199606)19:3<183::AID-NUR2>3.0.CO;2-G 8628907

23. Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. BMJ. 1998;317: 273–6. doi: 10.1136/bmj.317.7153.273 9677226

24. Bastiaens H, Van Royen P, Pavlic DR, Raposo V, Baker R. Older people’s preferences for involvement in their own care: A qualitative study in primary health care in 11 European countries. Patient Educ Couns. 2007;68: 33–42. doi: 10.1016/j.pec.2007.03.025 17544239

25. Caron CBB. Method and application of dimensional analysis: A contribution to concept and Knowledge devolepment in nursing. In: Saunders, editor. Concept devolopment in nursing: Foundations, thecniques and applications. Philadelphia: Saunders; 2000. pp. 285–320.

26. Strauss AL, Corbin JM. Basics of qualitative research: Techniques and procedures for developing grounded theory. SAGE publications, editor. London: SAGE publications; 1998. doi: 10.4135/9781452230153

27. Draucker CB, Martsolf DS, Ross R, Rusk TB. Theoretical Sampling and Category Development in Grounded Theory. Qual Health Res. 2007;17: 1137–1148. doi: 10.1177/1049732307308450 17928484

28. Barry CA, Britten N, Barber N, Bradley C, Stevenson F. Using Reflexivity to Optimize Teamwork in Qualitative Research. Qual Health Res. 1999;9: 26–44. doi: 10.1177/104973299129121677 10558357

29. Silverman D. Interpreting qualitative data: methods for analyzing talk, text, and interaction. London: Sage Publications; 2006.

30. Rodríguez-Martín B, Martínez-Andrés M, Cervera-Monteagudo B, Notario-Pacheco B, Martínez-Vizcaíno V. Perception of quality of care among residents of public nursing-homes in Spain: a grounded theory study. BMC Geriatr. 2013;13: 65. doi: 10.1186/1471-2318-13-65 23809066

31. Glasser BG, Holton J. Remodeling grounded theory. Forum Qual Sozialforsch. 2004;

32. Bernard H. R. Wutich A, Ryan GW. Analyzing Qualitative Data: Systematic Approaches. California: SAGE publications; 2010.

33. Jeon YH. The application of grounded theory and symbolic interactionism. Scand J Caring Sci. 2004;18: 249–256. doi: 10.1111/j.1471-6712.2004.00287.x 15355518

34. Morse JM, Barrett M, Mayan M, Olson K, Spiers J. Verification Strategies for Establishing Reliability and Validity in Qualitative Research. Int J Qual Methods. 2002;1: 13–22. doi: 10.1177/160940690200100202

35. European Foundation for Quality Management: EFQM Excellence Model 2010. Brussels; 2010.

36. Levenson SA. The basis for improving and reforming long-term care. Part 3: essential elements for quality care. J Am Med Dir Assoc. 2009;10: 597–606. doi: 10.1016/j.jamda.2009.08.012 19883881

37. Rodriguez-Martín B, Martínez-Andrés M, Cervera-Monteagudo B, Notario-Pacheco B, Martínez-Vizcaíno V. Preconceptions about institutionalisation at public nursing homes in Spain: views of residents and family members. Ageing Soc. 2014;34: 547–568. doi: 10.1017/S0144686X12001146

38. Sergeant JF, Ekerdt DJ. Motives for residential mobility in later life: post-move perspectives of elders and family members. Int J Aging Hum Dev. 2008;66: 131–154. doi: 10.2190/AG.66.2.c 18453180

39. Ehrlich K, Boström A-M, Mazaheri M, Heikkilä K, Emami A. Family caregivers’ assessments of caring for a relative with dementia: a comparison of urban and rural areas. Int J Older People Nurs. 2015;10: 27–37. doi: 10.1111/opn.12044 24433340

40. Garcia-Ptacek S, Dahlrup B, Edlund A-K, Wijk H, Eriksdotter M. The caregiving phenomenon and caregiver participation in dementia. Scand J Caring Sci. 2018; doi: 10.1111/scs.12627 30488971

41. Andrén S, Elmståhl S. The relationship between caregiver burden, caregivers’ perceived health and their sense of coherence in caring for elders with dementia. J Clin Nurs. 2008;17: 790–799. doi: 10.1111/j.1365-2702.2007.02066.x 18279282

42. Rodrigues AM, Ferré-Grau C, Ferreira PL. Being an Informal Caregiver of a Person with a Pressure Ulcer in the Azores Islands. Adv Skin Wound Care. 2015;28: 452–459. doi: 10.1097/01.ASW.0000471191.11548.dd 26375948

43. van der Weijden T, Boivin A, Burgers J, Schünemann HJ, Elwyn G. Clinical practice guidelines and patient decision aids. An inevitable relationship. J Clin Epidemiol. 2012;65: 584–589. doi: 10.1016/j.jclinepi.2011.10.007 22297117

44. Murray LM, Laditka SB. Care transitions by older adults from nursing homes to hospitals: Implications for long-term care practice, geriatrics education, and research. Journal of the American Medical Directors Association. 2010. pp. 231–238. doi: 10.1016/j.jamda.2009.09.007 20439041

Článek vyšel v časopise


2019 Číslo 12