Nurses’ Perceived Barriers to The Prevention of Pressure Injury and Related Factors in Indonesia

  • Yunita Sari Universitas Jenderal Soedirman
  • Arif Setyo Upoyo Universitas Jenderal Soedirman
  • Annas Sumeru Universitas Jenderal Soedirman
  • Wastu Adi Mulyono Universitas Jenderal Soedirman
  • Akhyarul Anam Universitas Jenderal Soedirman
Keywords: barriers, nurses, prevention, pressure injury


Background. Incidence of pressure injury (PI) in Indonesia is high. Therefore, Indonesian nurses should take measures to prevent PI from developing. Considering the high incidence of PI in Indonesia, there could be some barriers faced by Indonesian nurses in performing prevention of PI. However, to date, no study has assessed the perceived barriers and factors associated with perceived barrier of prevention of PI in Indonesian nurses. Therefore, this study aimed to assess perceived barriers to prevention of PI and associated factors in Indonesian nurses.

Methods. A total of 521 nurses participated in the study. A pressure injury prevention barriers questionnaire was used to assess perceived barriers of prevention of PI. A multivariate logistic regression model was used to analyse factors associated with the perceived barriers.

 Results. The two most commonly perceived barriers in nurses were lack of preventive devices such as special mattresses, cushions, and skin care products, and a lack of training courses related to prevention of PI. Associated factors emerging from the results were working experience (AOR =1.74) and working unit (AOR =2.73).


1. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J wound, ostomy, Cont Nurs Off Publ Wound, Ostomy Cont Nurses Soc [Internet]. 2016;43(6):585–97. Available from:
2. European Pressure Ulcer Advisory Panel NPIAP, Alliance and PPPI. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide 2019 Disclaimer [Internet]. Clinical gudelineas practice. 2014. 1–75 p. Available from:
3. Tubaishat A, Papanikolaou P, Anthony D, Habiballah L. Pressure Ulcers Prevalence in the Acute Care Setting: A Systematic Review, 2000-2015. Clin Nurs Res. 2018 Jul;27(6):643–59.
4. Hahnel E, Lichterfeld A, Blume-Peytavi U, Kottner J. The epidemiology of skin conditions in the aged: A systematic review. J Tissue Viability. 2017 Feb;26(1):20–8.
5. Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud [Internet]. 2020;105:103546. Available from:
6. Suriadi, Sanada H, Sugama J, Thigpen B, Subuh M. Development of a new risk assessment scale for predicting pressure ulcers in an intensive care unit. Nurs Crit Care. 2008;13(1):34–43.
7. Song Y-P, Shen H-W, Cai J-Y, Zha M-L, Chen H-L. The relationship between pressure injury complication and mortality risk of older patients in follow-up: A systematic review and meta-analysis. Int Wound J. 2019 Dec;16(6):1533–44.
8. Allman RM. Pressure Ulcer Prevalence, Incidence, Risk Factors, and Impact. Clin Geriatr Med [Internet]. 1997;13(3):421–36. Available from:
9. 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 Mar;57(5):494–504.
10. Padula W V, Delarmente BA. The national cost of hospital-acquired pressure injuries in the United States. Int Wound J. 2019 Jun;16(3):634–40.
11. Schmitt S, Andries MK, Ashmore PM, Brunette G, Judge K, Bonham PA. WOCN Society Position Paper: Avoidable Versus Unavoidable Pressure Ulcers/Injuries. J wound, ostomy, Cont Nurs Off Publ Wound, Ostomy Cont Nurses Soc. 2017;44(5):458–68.
12. Black JM, Edsberg LE, Baharestani MM, Langemo D, Goldberg M, McNichol L, et al. Pressure ulcers: avoidable or unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference. Ostomy Wound Manage. 2011 Feb;57(2):24–37.
13. Barker AL, Kamar J, Tyndall TJ, White L, Hutchinson A, Klopfer N, et al. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study. Int Wound J. 2013 Jun;10(3):313–20.
14. Amir Y, Lohrmann C, Halfens RJ, Schols JM. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment. Int Wound J. 2017 Feb;14(1):184–93.
15. Moore Z, Price P. Nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention. J Clin Nurs [Internet]. 2004 Nov 1;13(8):942–51. Available from:
16. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol from bed to bench. 2013;6(1):14–7.
17. Lopez-Franco MD, Parra-Anguita L, Comino-Sanz IM, Pancorbo-Hidalgo PL. Development and validation of the Pressure Injury Prevention Barriers questionnaire in hospital nurses in Spain. BMJ Open [Internet]. 2020 Dec 1;10(12):e041376. Available from:
18. Brislin RW. Back-translation for cross-cultural research. J Cross Cult Psychol. 1970;1(3):185–216.
19. Shi C, Dumville JC, Cullum N, Rhodes S, McInnes E. Beds and mattresses for treating pressure ulcers. Vol. 2020, The Cochrane Database of Systematic Reviews. 2020.
20. Panel EPUA. Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline. The International Guideline. EPUAP/NPIAP/PPPIA Prague, Czech Republic; 2019.
21. International W. International review. Pressure ulcer prevention: pressure, shear, friction and microclimate in context. A consensus document. Wounds International London (UK); 2010.
22. Bai D, Liu T-W, Chou H-L, Hsu Y-L. Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study. PLoS One. 2020 Nov 9;15:e0241276.
23. Hu L, Sae-Sia W, Kitrungrote L. Intensive Care Nurses’ Knowledge, Attitude, and Practice of Pressure Injury Prevention in China: A Cross-Sectional Study. Risk Manag Healthc Policy. 2021;14:4257–67.
24. Ebi WE, Hirko GF, Mijena DA. Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: A cross-sectional study design. BMC Nurs. 2019;18(1):1–12.
25. Pancorbo-Hidalgo PL, García-Fernández FP, López-Medina IM, López-Ortega J. Pressure ulcer care in Spain: Nurses’ knowledge and clinical practice. J Adv Nurs. 2007;58(4):327–38.
26. Aydin AK, Karadağ A. Assessment of nurses’ knowledge and practice in prevention and management of deep tissue injury and stage I pressure ulcer. J wound, ostomy, Cont Nurs Off Publ Wound, Ostomy Cont Nurses Soc. 2010;37(5):487–94.
27. de Azevedo Macena MS, da Costa Silva RS, Dias Fernandes MIDC, de Almeida Medeiros AB, Batista Lúcio KD, de Carvalho Lira ALB. Pressure Ulcer Risk Evaluation in Critical Patients: Clinical and Social Characteristics. Open Nurs J. 2017;11:91–7.
28. Coyer F, Miles S, Gosley S, Fulbrook P, Sketcher-Baker K, Cook J-L, et al. Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison. Aust Crit Care. 2017 Jan 4;30.
29. He M, Tang A, Ge X, Zheng J. Pressure Ulcers in the Intensive Care Unit: An Analysis of Skin Barrier Risk Factors. Adv Skin Wound Care [Internet]. 2016;29(11). Available from:
30. Labeau SO, Afonso E, Benbenishty J, Blackwood B, Boulanger C, Brett SJ, et al. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study. Intensive Care Med [Internet]. 2021;47(2):160–9. Available from:
31. Zuo X-L, Meng F-J. A care bundle for pressure ulcer treatment in intensive care units. Int J Nurs Sci [Internet]. 2015;2(4):340–7. Available from:
32. Jacq G, Valera S, Muller G, Decormeille G, Youssoufa A, Poiroux L, et al. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The PRESSURE study. Aust Crit Care. 2021;34(5):411–8.
33. Masyitha K, Haryanto, Puspita D, Suriadi, Usman. Pressure ulcers related to medical device in intensive care in Indonesia: A prospective study. Enfermería Clínica [Internet]. 2020;30:87–91. Available from:
34. de Assis IIC, Estevam Dos Santos J, Valadares Sinicio Abib ML, Furtado Bueno L, de Mendonça Figueirêdo Coelho M, Nogueira Cortez D, et al. Medical Device-Related Pressure Injury in an Intensive Care Unit: A Cross-Sectional Study. Wound Manag Prev. 2021 Nov;67(11):26–32.
35. Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR. Medical device related pressure ulcers in hospitalized patients. Int Wound J [Internet]. 2010 Oct 1;7(5):358–65. Available from:
How to Cite
Sari, Y., Upoyo, A. S., Sumeru, A., Mulyono, W. A., & Anam, A. (2023). Nurses’ Perceived Barriers to The Prevention of Pressure Injury and Related Factors in Indonesia. Journal of Bionursing, 5(2), 119-127.