eISSN 2097-6046
ISSN 2096-7446
CN 10-1655/R
Responsible Institution:China Association for Science and Technology
Sponsor:Chinese Nursing Association
Research Paper

Barriers and facilitators to mucose membrane pressure injury prevention and management in intensive care units

  • HE Jingjing ,
  • FU Yichao ,
  • TAO Jin ,
  • CAO Yangyang ,
  • QIAO Li ,
  • LI Hui ,
  • HUANG Ping
Expand
  • Department of EmergencyNanjing Drum Tower HospitalNanjing 210003, China
*Fu Yichao,E-mail:yichao_fu@163.com

Received date: 2025-08-22

  Online published: 2026-08-04

Supported by

General Nursing Research Project of Nanjing Drum Tower Hospital(2023-H766)

Abstract

Objective To explore the barriers and facilitators encountered by intensive care unit(ICU) nurses in the prevention and management of mucous membrane pressure injuries(MMPI). Methods A descriptive qualitative study design was employed. Semi-structured interviews were conducted with ICU nurses from a tertiary Grade A hospital in Nanjing. Thematic analysis was used to organize,code,and analyze the data. The identified themes were then mapped onto the Theoretical Domains Framework(TDF) to systematically identify barriers and facilitators influencing MMPI prevention and management. Results Interviews were conducted with 12 ICU nurses. The coded interview data mapped to 14 theoretical domains,yielding 8 main themes and 23 sub-themes. The promoting factors for the implementation of MMPI included three themes,including physician-nurse cooperation and manager support,knowing the significance of MMPI management,management supervision and personal characteristics. The theme of barriers included four themes,including insufficient cognition and skills of MMPI,decision-making dilemma caused by multiple consequences beliefs,lack of confidence in the effect of prevention management,and negligibility of MMPI. The theme of human resources and prevention materials was not only a barrier factor but also a promoting factor. Conclusion The factors influencing nurses’ prevention and management of MMPI are complex. The findings of this study can inform clinical practice by leveraging facilitators while mitigating barriers,ultimately aiming to reduce the incidence of MMPI in critically ill patients.

Cite this article

HE Jingjing , FU Yichao , TAO Jin , CAO Yangyang , QIAO Li , LI Hui , HUANG Ping . Barriers and facilitators to mucose membrane pressure injury prevention and management in intensive care units[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026 , 7(8) : 901 -907 . DOI: 10.3761/j.issn.2096-7446.2026.08.001

References

[1] 刘天贶, 龙玉娟, 刘欢, 等. ICU患者不同部位黏膜压力性损伤的特征及护理研究进展[J]. 护理学报, 2022, 29(8):35-39.
  Liu TK, Long YJ, Liu H, et al. Characteristics and nursing research progress of mucosal pressure injury in different parts of ICU patients[J]. J Nurs China, 2022, 29(8):35-39.
[2] Fulbrook P, Lovegrove J, Miles S, et al. Systematic review:incidence and prevalence of mucous membrane pressure injury in adults admitted to acute hospital settings[J]. Int Wound J, 2022, 19(2):278-293.
[3] Nan RL, Su YJ, Pei JH, et al. Characteristics and risk factors of nasal mucosal pressure injury in intensive care units[J]. J Clin Nurs, 2023, 32(1/2):346-356.
[4] Reaper S, Green C, Gupta S, et al. Inter-rater reliability of the reaper oral mucosa pressure injury scale(ROMPIS):a novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa[J]. Aust Crit Care, 2017, 30(3):167-171.
[5] National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers:clinical practice guideline[EB/OL]. (2014-04-23)[2025-10-27]. https://cdn.ymaws.com/npiap.com/resource/resmgr/2014_guideline.pdf.
[6] 高杰, 周会兰, 陈柯宇, 等. ICU病人鼻黏膜压力性损伤的研究进展[J]. 护理研究, 2023, 37(20):3659-3664.
  Gao J, Zhou HL, Chen KY, et al. Research progress of nasal mucosal pressure injury in ICU patients[J]. Chin Nurs Res, 2023, 37(20):3659-3664.
[7] 张莹莹, 张娟, 冯敏, 等. 神经外科重症气管插管患者口腔黏膜压力性损伤预防管理的审查指标制订及障碍因素分析[J]. 护士进修杂志, 2025, 40(3):256-263.
  Zhang YY, Zhang J, Feng M, et al. Establishment of review indexes and analysis of obstacle factors for prevention and management of oral-mucosal pressure injury in patients with severe tracheal intubation in neurosurgery[J]. J Nurses Train, 2025, 40(3):256-263.
[8] Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems[J]. Implement Sci, 2017, 12(1):77.
[9] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research(COREQ):a 32-item checklist for interviews and focus groups[J]. Int J Qual Health Care, 2007, 19(6):349-357.
[10] Erbay Dall? ?, Kelebek Girgin N. Medical device-related pressure injury care and prevention training program(DevICeU):effects on intensive care nurses’ knowledge,prevention performance and point prevalence[J]. Intensive Crit Care Nurs, 2024, 82:103622.
[11] Gao ZH, Zhang XH, Deng ZQ, et al. ICU nurses’ knowledge,attitudes,and practice of oral mucosal pressure injury towards patients with orotracheal intubation:a cross-sectional study[J]. BMC Nurs, 2025, 24(1):704.
[12] 卿晨, 陈玲, 叶宇杰, 等. 临床护士预防患者黏膜压力性损伤的知信行现状及影响因素研究[J]. 护士进修杂志, 2025, 40(8):824-830.
  Qing C, Chen L, Ye YJ, et al. Current situation of clinical nurses’ knowledge,attitude,and practice on preventing mucosal membrane pressure injuries in patients and its influencing factors[J]. J Nurses Train, 2025, 40(8):824-830.
[13] Chen GJ, Li XQ, Li XZ, et al. Mucosal membrane pressure injury in intensive care units:a scoping review[J]. Intensive Crit Care Nurs, 2024, 80:103560.
[14] Coyer FM, Stotts NA, Blackman VS. A prospective window into medical device-related pressure ulcers in intensive care[J]. Int Wound J, 2014, 11(6):656-664.
[15] 缪苗, 张培培, 徐鑫, 等. 难免性压力性损伤发生及鉴别评估的研究进展[J]. 中国实用护理杂志, 2023, 39(21):1671-1675.
  Miao M, Zhang PP, Xu X, et al. The mechanism of occurrence and differential assessment of unavoidable pressure injuries:a literature review[J]. Chin J Pract Nurs, 2023, 39(21):1671-1675.
[16] Schroeder J, Sitzer V. Nursing care guidelines for reducing hospital-acquired nasogastric tube-related pressure injuries[J]. Crit Care Nurse, 2019, 39(6):54-63.
[17] Kang MK, Kim MS. Effects of attitude,barriers/facilitators,and visual differentiation on oral mucosa pressure ulcer prevention performance intention[J]. Healthcare, 2021, 9(1):76.
[18] Barker A, Doeltgen S, Lynch E, et al. Perceived barriers and enablers for implementing water protocols in acute stroke care:a qualitative study using the Theoretical Domains Framework[J]. Int J Speech Lang Pathol, 2019, 21(3):286-294.
[19] Almuhanna Z, Bohulaigah Z, Alkhawaja H, et al. Posterior trachea wall erosion:a case report and literature review of a catastrophic complication of cuff overinflation[J]. J Surg Case Rep, 2025, 2025(6):rjaf361.
[20] 中华医学会呼吸病学分会呼吸治疗学组. 人工气道气囊的管理专家共识(草案)[J]. 中华结核和呼吸杂志, 2014, 37(11):816-819.
  Respiratory Therapy Group of Respiratory Disease Branch of Chinese Medical Association. Expert consensus on the management of artificial airway airbags(draft)[J]. Chin J Tuberc Respir Dis, 2014, 37(11):816-819.
[21] Kelly-O’Flynn S, Mohamud L, Copson D. Medical adhesive-related skin injury[J]. Br J Nurs, 2020, 29(6):S20-S26.
[22] Buckley JC, Brown AP, Shin JS, et al. A comparison of the haider tube-guardR endotracheal tube holder versus adhesive tape to determine if this novel device can reduce endotracheal tube movement and prevent unplanned extubation[J]. Anesth Analg, 2016, 122(5):1439-1443.
[23] Padula WV, Pronovost PJ, Makic MBF, et al. Value of hospital resources for effective pressure injury prevention:a cost-effectiveness analysis[J]. BMJ Qual Saf, 2019, 28(2):132-141.
[24] Registered Nurses’ Association of Ontario. Risk Assessment & Prevention of Pressure Ulcers[EB/OL]. (2025-03-01)[2025-07-18]. https://rnao.ca/sites/rnao-ca/files/Risk_Assessment_and_Prevention_of_Pressure_Ulcers.pdf.
[25] 陈芳, 江智霞, 杨明静, 等. 贵州省ICU护理人员对机械通气患者口渴认知及干预行为的调查研究[J]. 中华护理杂志, 2023, 58(9):1104-1111.
  Chen F, Jiang ZX, Yang MJ, et al. A study on the perceptions and behaviors of ICU nursing staff on thirst in mechanically ventilated patients in Guizhou Province[J]. Chin J Nurs, 2023, 58(9):1104-1111.
[26] Aarons GA, Green AE, Trott E, et al. The roles of system and organizational leadership in system-wide evidence-based intervention sustainment:a mixed-method study[J]. Adm Policy Ment Health, 2016, 43(6):991-1008.
[27] Wu ZJ, Song B, Liu Y, et al. Barriers and facilitators to pressure injury prevention in hospitals:a mixed methods systematic review[J]. J Tissue Viability, 2023, 32(3):355-364.
Outlines

/