Family caregivers' perceptions and challenges in the care of pressure injuries in a daily life: a qualitative field study

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Therefore, key coping strategies for caregivers in the practice of identifying, preventing, and cooperating with the treatment of pressure injuries were proposed. Methods: From June to December 2023, 17 older patients with pressure injuries were observed and 17 family caregivers were interviewed using a field study design that included semi-participatory observation and in-depth interviews. Field notes were analysed using a qualitative three-level coding method. Results: Eight themes were extracted after analysing the on-site observation records and interviews. These included four topics on care content (food preparation and feeding support, maintaining hygiene, postural change and use of supports, use of medication, and dressing), two perception topics (responsible care and compensatory companion, grief, and helplessness), and two challengetopics (identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources). Conclusion: Family caregivers still provide inappropriate pressure injury care, for example, in terms of frequency of body position changes and ways to keep wounds clean and hygienic. The education of family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs and introduce teaching cases when appropriate. To facilitate access to professional care and counselling resources for pressure injuries, the community can be united to carry out systematic science popularisation by using various effective media such as new media and video channels. Pressure injury Family caregivers Daily life Challenge Field research Background Pressure injury refers to local damage to the skin and/or soft tissue caused by pressure or combined shear forces. These often occur in bone prominences but may also be associated with medical or other devices [ 1 ]. Depending on the venue where they occur, they are divided into community-acquired pressure injuries (CAPI) and hospital-acquired pressure injuries. CAPI include pressure injuries that occur in nursing homes and private residences. Internationally, according to the degree of skin and tissue loss, they are usually divided into stages 1 to 4, as well as unstageable pressure injury, and deep tissue pressure injury [ 1 ]. In recent years, with the ageing of society and changes in the disease spectrum, the incidence of pressure injuries remains high and represents a global nursing problem. Patients often experience pain, seepage, odours, and other symptoms that seriously affect their quality of life. Pressure injury patients need family caregivers to provide timely rehabilitation, nutrition, emotional support, and wound dressing changes. Family caregivers often connect patients and nursing professionals, and the level of family caregivers' participation in care plays a key role in patients' wound healing and improving their quality of life [ 2 ]. Even if family caregivers play an important role, their lack of knowledge, care skills, early warning and identification ability, and attention to pressure injuries can lead to not only delayed medical treatment but also neglect of long-term care and home management of pressure injury patients, exacerbating the occurrence and development of these injuries [ 3 ]. According to interpersonal interaction theory/dualistic coping theory, family caregivers and patients support each other, and family caregivers can be sources of stress or providers of positive resources. If family caregivers have better coping and emotional regulation abilities, they will be better able to care for patients with pressure injuries [ 4 ]. Family caregivers deal with the initial occurrence of pressure injuries as stressful events. In many cases, first-time caregivers have no experience and can easily overlook important observation points, which aggravates the progress of pressure injury recovery and delays the best time to turn to professional medical treatment. The following questions need to be addressed. What is the in-practice status of caregivers’ treatment of initial pressure injuries? What discrepancies exist between the care provided and the care expected by medical teams? What are the warning signs that aggravate or suggest changes in conditions that are easy to miss in this type of care? To answer these questions, using field research [ 5 ], this project aimed to understand the current situation of caregivers' nursing practice for initial pressure injuries. Through reflection on the current situation, we further explore and identify the discrepancies between the actual care provided to this population group and the methods of prevention and treatment of pressure injuries recommended by the guidelines, as well as the difficulties in practical nursing care for initial pressure injuries. This is of great significance in helping caregivers to recognise, prevent, and provide cooperative treatment of pressure injuries. Methods In 2023, we conducted a qualitative approach using field research and in-depth semi-structured interviews with caregivers of patients with pressure injuries in Suzhou, China. Participants and settings The community in which 17 families lived was selected as the field. We selected family caregivers who took care of initial pressure injuries in the field between May and October 2023 as key informants. The following inclusion criteria for caregivers were applied: (1) family caregivers aged at least 18 years; (2) the caregiver provided the most care time and provided the care for the patient’s initial pressure injury; (3) the caregiver provided informed consent to participate in the study. Exclusion criteria were those with mental disorders or those unable to communicate. Data collection and methodology The researcher participative observation method was used to collect data. The observation process consisted of three stages: descriptive, focus, and selective observations. When researchers enter a field, they conduct descriptive observations. This involves establishing basic relationships, for example by talking to patients and family members. This stage focuses on describing the workflow of the family caregiver’s daily care of the patient and understanding the general situation in the field. Focus observation was conducted after communicating with the caregivers. The observation period was 07:30–18:30 every day, according to the caregiver’s accompanying time. The study focused on prevention and treatment recommendations for ‘populations in the community, the elderly care, and rehabilitation settings’ in the 2019 Prevention and Treatment of Pressure Ulcers/Injuries developed by the European Pressure Ulcer Advisory Panel [ 1 ], including how to prevent pressure injuries (e.g. supports, position changes, use of dressings), nutritional support (e.g. how to provide food), how to assist professional nursing staff to treat pressure injuries. Nursing content outside the observation period was obtained through communication with nurses, doctors, and patients/families. Field shorthand, audio recordings (with the consent of the interviewee), photography, and other methods were used to collect relevant data. According to the saturation degree of the data in the later analysis process, representative nursing cases for the prevention and treatment of pressure injuries were selected, and the interaction process between patients and caregivers and the reaction of caregivers were selectively observed. We carefully depicted the moments and processes observed in vivid detail. The entire observation period lasted for 6 months. Data analysis We collected data rooted in this context. Within 24 hours after the end of field observation, the researchers combined the collected data and their own memories to compile field notes and recorded their reflections and perceptions of the field research for that day. Through repeated reading of the field notes, the researchers extracted problems from the original materials and reflected on them. In the subsequent field research, repeated observations, continuous thinking, and comparisons were conducted for the problems found. Work content analysis was conducted using three qualitative research coding methods: open, axial, and selective coding. Open coding was performed by two researchers who repeatedly read the field notes, and the coding process presented the original content of the field notes as much as possible. The third researcher summarised the coding results of the same field notes, recorded the disputed codes, discussed them collectively, and determined them by listening to expert opinions when necessary. For axial coding, one researcher summarised the open coding notes in a centralised manner, and other researchers in the team proposed modification suggestions. To reach an agreement and explain the relevant categories, selective coding involved the collaboration of two researchers to mine and establish relationships between genera to form a core genus that covered all genera. After the preliminary extraction, the original field notes and coding results were submitted to other members of the research team and experts for review and, if necessary, returned to the department of key insiders for verification to improve the credibility of the data. Ethics and quality control Before conducting the field study, the researcher explained the purpose of the study to the participants, promising that all their speech and behaviour observations were for research analysis only and that their real names would not appear in any of the records. After obtaining the consent of the observed participants and signing the informed consent form, the researcher asked the observed family caregivers to participate in the care of pressure injuries from the perspective of daily life. During the observation process, the researcher did not evaluate or intervene in the observed speech and behaviour. The research group held seminars regularly to discuss progress in this field research. We analysed the problems found in the study and identified the focus of further research to improve the credibility and comprehensiveness of the findings. This study was approved by the Ethics Committee of Soochow University (No. SUDA20231020H02). Results Characteristics of the field, family caregivers, and patients This community (the field) is located in the Yangtze River Delta, Taihu Lake Basin, in the centre of Suzhou, a famous historical and cultural city. Suzhou is an important economic, trade, industrial, commercial, and regional distribution centre, and has a home care service workstation and a community healthcare centre. A total of 17 family caregivers, aged 48–79 (57.41 ± 9.21) years, were interviewed and observed in this study. Most family caregivers had received at least six years of basic education, eight (47.06%) had been educated in primary school or lower level, five (29.41%) in junior high school, and four (23.53%) in senior high school. Fourteen family caregivers were female, including eight daughters (47.06%), three wives (17.65%), two sons (11.76%), one husband (5.88%), and three daughters-in-law (17.65%). The duration of care ranged from 2 to 204 months (Table 1 ). Table 1 Demographic data of family caregivers Number Gender Age (years) Education background Relationship with patient Duration of care (months) CG1 female 48 junior high daughter 12 CG2 male 79 none husband 2 CG3 female 50 junior high daughter 6 CG4 female 45 senior high daughter 16 CG5 female 52 junior high daughter-in-law 3 CG6 female 47 primary school daughter 28 CG7 female 50 junior high daughter 6 CG8 female 56 primary school daughter-in-law 12 CG9 female 57 none daughter-in-law 18 CG10 male 54 primary school son 12 CG11 female 55 primary school daughter 15 CG12 female 71 primary school wife 204 CG13 female 65 junior high wife 48 CG14 female 68 none wife 24 CG15 male 60 senior high son 12 CG16 female 57 senior high daughter 48 CG17 female 62 senior high daughter 24 [Insert Table 1 about here] The demographic data of patients with pressure injuries and their characteristics are shown in Table 2 . The patients’ ages ranged from 68 to 86 (78.47 ± 5.35) years, including 9 female patients. The wound duration ranged from 0.5 to 12 (2.42 ± 2.71) months. The pressure injury stages were as follows: stage 4 (30.43%, 7/23), stage 3 (21.74%, 5/23), stage 2 (39.13%, 9/23), and stage 1 (8.70%, 2/23). Table 2 Demographic data of patients with pressure injury and characteristics of pressure injury Number Gender Age (years) Wound duration (months) Wound size [length (cm)*width (cm)*depth (cm)] Stage* Location Total number of pressure injuries P1 female 75 2 6*7*3 4 sacrococcygeal region 3 P2 female 78 1 7*8*4 4 sacrococcygeal region 1 P3 male 76 2 7.5*8,5*2.5 4 sacrococcygeal region 1 P4 female 78 0.5 4*4*1 2 right ankle 1 P5 female 83 3 4*5*2 4 right heel 1 P6 female 74 4 3*2*2 3 sacrum 1 P7 female 78 1 2*3*1 2 sacrococcygeal region 1 P8 female 84 4 1*2*0.3 2 right back 1 P9 female 82 2.6 2*2*1,7*7*2, 4*4*0.8, 3*4*1 2 (3), 1 (2) # sacrococcygeal region, right forearm, heels, back 5 P10 male 86 1 1*1*0.3 2 left shoulder 1 P11 male 79 1 3*4*0.1, 1*1*0.2 2 sacrococcygeal region 2 P12 male 73 2 2*2*0.3 2 left hip 1 P13 male 68 12 2*2*1, 2*4*1 3,4 sacrococcygeal region 5 P14 male 70 0.5 7*10*0.8 3 sacrococcygeal region 3 P15 male 85 0.5 3*5*1, 1*2*1 3,4 back 2 P16 female 85 2 1.5*2.7*1 3 back 1 P17 male 80 2 2.8*3.5*0.8 4 left foot 1 Note: *: stage 1; stage 2; stage 3; stage 4. #2 (3): There are three pressure injuries diagnosed as stage 2. 1 (2): There are two pressure injuries diagnosed as stage 1. [Insert Table 2 about here] Eight themes were extracted after analysing the on-site observation records and interviews. These include four topics on care content (food preparation and feeding support, maintaining hygiene, postural change and use of support, use of medication, and dressing), two perception topics (responsible care and compensatory companions, grief, and helplessness), and two challenge topics (identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources). Discrepancies between family and professional caregivers in pressure injury care practice Sub-theme 1: family caregivers are experienced and skilled in food preparation and feeding support while professional caregivers have little time to prepare During the field observations and interviews with the family caregivers, most were good at and experienced with food preparation. If family caregivers are too busy to prepare food, they arrange for care workers to provide nutritious food (CG16). CG3 carefully prepared different rice cereals, mushy noodles, shredded dried meat, and a wide variety of other foods suitable for P3 to eat every day, and viewed food preparation as extremely important. CG8 also personalised P8’s diet: ‘She, since last year, cannot chew, and so our family members will buy some protein powder and brew for her, basically, some vegetable juice, juice, rice paste, and sometimes along with some chicken breast puree, minced meat mixed together as her meals, so as to ensure her nutrition’. CG16: ‘In terms of food, we ask our nanny to prepare three meals a day, and I won’t let my mom cook or do housework since her diagnosis of chronic obstructive pulmonary disease. You know, she often feels tired and short of breath’. Sub-theme 2: family caregivers must update their standards for choosing cleaning equipment to maintain hygiene We found that 47.06% of caregivers (8/17) did not perform skin cleaning in accordance with the guidelines on body care and the use of sanitary paper. For example, we observed inappropriate behaviours such as family caregivers using rough paper to wipe faeces (to save money), using alkaline soap to clean the skin of patients (regardless of weak acid lotion), and using diapers to collect urine for patients who can urinate normally, simply to reduce the workload of care. CG11 would complain to the researchers: ‘We have been using this kind of toilet paper for many years, and none of us had any adverse reactions, why should we switch to wet wipes?’ CG8 would always make sure that there were enough diapers available, and when not many were left, she would immediately contact other family members by phone and ask them to buy them in advance. However, although P8 had a pressure injury, she was not incontinent and could get out of bed to urinate by herself. The pressure injury to her back was caused by sitting in a wheelchair for too long. CG8 thought that if P8 wore the diaper and sat in a wheelchair, she could deal with other piecemeal housework, such as shopping for food, feeding, and medicine administration, but CG8 had no idea about checking the saturation level of the diaper frequently. CG8 did not change the diaper until the patient’s hips became extremely red. The above situation must not be allowed to happen in hospitals or medical and health service units when patients are cared for by professional caregivers. Sub-theme 3: family caregivers have questions about the details of changing positions and using upholder supports (e.g. mattresses) In daily life, family caregivers are not very clear about the details of position change; most family caregivers just know ‘turn over’, but the frequency of turn over, the angle, and the upholders remain unclear. For patients bound to wheelchairs, most family caregivers cannot take timely measures to reduce pressure. Moreover, family caregivers have doubts about the methods of choosing a buttress. When P4 basks in the sun during the day, CG4 will arrange for P4 to sit in the wheelchair and only cover P4’s knees with a quilt, and then CG4 will deal with other affairs. CG4: ‘In fact, it is very difficult to calculate when I should do something, especially it is impossible to remember when it is time to change the position of CG4 or reduce the pressure; basically, I will decide to reduce the pressure by my own feeling, or I will ask P4 herself whether she is tired and if there is a need to change the position?’ CG16: ‘My mother now has bedsores (pressure injuries); I felt a little confused, I do not know what else to do except for turning over for her every day? Someone told me to use air-cushion mattresses, so I quickly bought one online. Is there any other better option for pressure redistribution?’ CG9: ‘You know, P9 has so many pressure injuries; I use some pillows, as well as my own handmade, stuffed some spongy cushions, so that she may be more comfortable’. CG7: ‘In our home setting, we have never considered a mattress in the prevention or treatment of pressure injuries; actually, I do not know where to find a professional, suitable mattress for her?’ Sub-theme 4: Family caregivers have access to a wide range of drugs and dressings for the prevention and treatment of pressure injuries, but most neglect decompression dressings Non-medical professionals are less aware of the types of medical dressings available. In the home setting, they often obtain medicinal extracts, powders, and dressings for the prevention and treatment of pressure injuries from pharmacies, friends, and neighbours, but often ignore the role of decompression dressings. For example, CG17: ‘We have heard that a special kind of powder can work, so, once there is a little break on his butt, I will sprinkle it on him; initially, it did work, but now the wound is larger, I can't control it, and it is useless to sprinkle the powder. I went to community health services where there were no recommended ointments’. CG10: ‘I have been a live-in nanny for many years, and I have met two aged persons with pressure injuries on their buttocks, both of which were coated with golden cream (a kind of Chinese ointment) I bought, so when I was taking care of P10, I was very experienced and shared with the families that I had used dressings that I thought were very good’ (CG10's face showed a smug expression). ‘However, some inexperienced family caregivers also become confused’. CG1: ‘In the aspect of pressure injury treatment, I feel very confused, because bringing older adults to the hospital is really time-consuming and troublesome. You know, she has now basically lost the ability to move; firstly, we not only have to gather relatives with a car to the hospital but also find family caregivers whose bodies are strong and lusty to transfer her. Above all, one of the family caregivers must be able to communicate with the doctor. Therefore, we may go to the hospital once or twice, and then according to the doctor's guidance, our family members take turns to change her dressings (of course, I am the primary caregiver; others dare not change the wound dressings). If there is no time to go to the hospital, I will take photos of her wounds to show the doctor, but I go to many hospitals; for my mother's pressure injuries, different hospitals may prescribe different medicines/dressings. Some were poultices, some were dressings, so in just two months, our family bought different kinds of drugs and dressings, but I didn't feel that they made her pressure injury any better’. In the field observation, we found that most caregivers held the opinion that the wounds needed to be ventilated, kept dry, and did not want to wrap too many dressings, such as some occlusive dressings. The researchers involved in the study suggested that family caregivers could use decompression dressings; however, in many cases, caregivers rejected them because of the high frequency of dressing changes, the cost burden to the family, and the potential impact on wound permeability. Psychological perception of family caregivers participating in pressure injury nursing practice The psychological processes of family caregivers involved in pressure injury nursing care are complex and contradictory. The target population who needs family caregivers to participate in the nursing practice of preventing and treating pressure injuries is often disabled, and disabled people need not only the help of family caregivers in physical care and daily life care but also more love and companionship from family caregivers. Sub-theme 1: responsible care and compensatory companionship CG16: ‘My brother is a businessman; my mother used to follow my brother to cities all over the country, and my mother took care of my brother’s family at that time. I didn't have enough time to do my duty to take care of my parents before, and now that I'm retired and free, I picked them up and did my best to take care of them. Sadly, in recent years, my parents have not been very well, and I took care of them, which can be regarded as my filial piety’. CG6: ‘Well, this year, I have been to the hospital many times, and the patient has been hospitalised twice, and I asked the doctor a lot about his primary diseases, he has been unable to eat, and every child shift in queue to accompany him, there is nothing to do but stay there with him’. CG5: ‘When someone in your family is sick, what can you do but directly face it? My husband is the only child; he is very busy, and I have to take care of my mother-in-law out of my responsibility. My mother-in-law has been very helpful to our family, and my children were brought up by my mother-in-law and my father-in-law, and I am so grateful to them, and I should do something to help them when they need it in return’. In families with close relationships, family caregivers of patients with pressure injuries may devote more effort to providing emotional support, time, and economic expenditure. We observed that if there are multiple children in a family, patients and caregivers are closer to each other, and visits are usually more frequent. A filial family caregiver was even resigned to accompanying the patient, taking care of her grandmother day and night, while she strictly followed the frequency of turn over every two hours, complying with the medical staff’s order. Most of the psychological perceptions of family caregivers participating in the nursing practice of pressure injuries are shouldered with responsibility, and they feel the need to provide compensatory and grateful care to repay the nurturing grace of their relatives. Sub-theme 2: grief and helplessness In the practice of caring for pressure injuries involving caregivers in many family roles, sadness, reluctance, anxiety, and helplessness were identified. CG15: ‘My dad has been lying in bed for a long time due to illness. Last month, he went to the hospital because of ascites, but the doctors said there were no good treatment methods, so he went home without any other treatment. As his children, we took turns taking care of him. *Sigh* (with eyes turning red), the problem (pressure injury) appeared half a month ago; at first, we went to the health clinic and bought the ointment by following the doctor’s advice. Whatever, his life is about to end. Luckily, I have plenty of time these days. I will do my best to take care of him, after all, I have only one dad...’ CG3: ‘At first, I found his skin red and slightly damaged, I thought it was just a scratch. I squeezed some scald cream onto the wound, but I didn't search for multiple treatments. One night later, I didn't expect it to worsen but it did happen. His skin turned black and hard, which scared us. I didn’t know what to do. I called the community health service centre, and they asked us to visit the tertiary hospital quickly. As a result, I went to the hospital and wandered around, mistakenly calling the wrong consultation room. I was in a hurry, without anyone guiding me, feeling very powerless and helpless’. We found that CG2 often took diligent care of P2, reducing the pressure frequently, putting cushions on him, and chatting with him. As he talks, he gradually becomes silent, conveying a heavy emotional response, especially when he helps P4 change his dressings and sees P4's wound. He gently touches P4's head, asks her to hold on for a while, and soon changes the dressings by himself. He also blames himself for not taking good care of P4, which caused the pressure injury. Exploring the difficulties of family caregivers in pressure injury care practice The family caregivers are not professional caregivers. After on-site observation of these 17 family caregivers and patients, they also faced two major difficulties in pressure injury care practice: identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources. Sub-theme 1: identifying and alerting barriers to pressure injury Seventeen family caregivers mentioned more than once that the patient had little red spots, erythema, and they did not take it seriously, and later it gradually developed into a pressure injury, or several family caregivers thought that it may be eczema and that it was good to blow it and keep the affected area dry. CG9 mentioned: ‘I am very good at recognising pressure injuries, and every time I remind P9’s other family members that there is redness in this area, we should pay attention to it, and sprinkle some baby powder to keep her place dry, so that it will not worsen’. However, CG9 was overconfident; her measures were not in line with practice guidelines, and the warning signs she mentioned were not comprehensive. CG13 believed that her husband was allergic and that his skin was sensitive; therefore, he often showed redness. CG7 expressed regret for not recognising and treating her earlier: ‘Oh, I was too busy a few days ago, the times I went home decreased, and then when one day I came back to turn her over, I suddenly found this wound; hey, if I had found it earlier, it would have been easier to treat the wound and promote her wound healing faster’. Sub-theme 2: shortage of professional care and counselling resources Of the 17 family caregivers, 58.82% indicated that their patients had no access to professional knowledge or resources since the pressure injury occurred. This suggests the need to strengthen science popularisation resources in the community and increase professional care and consultation resources. CG5: ‘I wish I knew the consultation resources and treatment procedures earlier, so that it may not take too long to go to the doctor’. CG16: ‘My mother has Parkinson's disease, her respiratory system is not very good, she always has dyspnoea when she walks for several metres, her lumbar spine is not very good, and she has a hunchback, which cannot withstand the hospital tossing back and forth; if someone comes to the house, or I can get care resources anytime and anywhere, it is very beneficial for me. It is best to have a professional caregiver set up a consultation point at the community health service centre in front of my home because it is close, and I can run to ask questions about pressure injury timely, furthermore, I can save my precious time to improve the work efficiency’. Discussion When family caregivers participate in pressure injury care practice, they still perform inappropriate caring procedures (e.g. frequency of postural change and keeping the wound clean and hygienic) An Indonesian study [ 6 ] confirmed that almost no CAPI patients were cared for by family caregivers prior to hospitalisation, despite living with family members and other relatives, and that effective cooperation and involvement of family caregivers in the treatment of PI directly increased the likelihood of recovery [ 7 ], although this possibility has not been supported by longitudinal studies. Mastering the caregiving skills associated with pressure injuries is mostly the responsibility of the family caregiver. Lack of attention to the role of family caregivers can lead to poor knowledge and ability of family caregivers to prevent pressure injuries, which in turn may increase the chances of patients developing pressure injuries. Rafiei et al. [ 4 ] advocated that family caregivers should be involved in the care of patients with pressure injuries, and strategies for improving the skills of caregivers should be investigated further. In the field investigation of family caregivers in this study, most family caregivers could complete basic daily care content, especially diet, which is probably in accordance with the Chinese culture of ‘food is people's foremost/primary concern’ [ 8 ]. It seems that in daily life, family caregivers are mainly responsible for providing food. The food they provide to patients is sufficient, nutritious, and diverse. However, the study found that the shortcomings of family caregivers' care lie in the frequency of changes in body position and the lack of methods to maintain cleanliness and hygiene. In the eyes of family caregivers, patients are still considered normal people and are not treated as vulnerable people with damaged skin barriers. Ways to reduce pressure and clean the skin of people with disabilities are often overlooked. Education for family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs A British study [ 4 ] confirmed that 81% of patients with pressure injuries lived at home before admission and ignoring the early warning signs of pressure injuries led to declines in quality of life. Once pressure injuries occur, the wound healing cycle becomes too long to predict the prognosis. This field study also found that most family caregivers may miss early warning signs, and the likelihood of systemic infection will be reduced; if the pressure injury is not so severe as to reach stages 3 and 4, its treatment duration and economic expenditure can be reduced. Therefore, ‘prevention is better than treatment’, and education for family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs. Currently, China is becoming an ageing society, and most current family caregivers are middle-aged or older. Therefore, education should be conducted in a simple and understandable form, and real cases can be incorporated into health education, to attract audience interest. To promote the availability of professional care and counselling resources for pressure injuries, the community can play an important role in conducting science popularisation using various effective media As society enters an era of advanced ageing, pressure injuries, a common complication, have attracted the attention of researchers. In China, where families have traditionally been involved in the care of older adults and those with chronic disease, the following question arises: how can communities be utilised to keep disabled family members at home for as long as possible for long-term home care? It is vital to use effective media to conduct science popularisation activities to facilitate access to professional care and counselling resources for pressure injuries. Social media, including websites, forums, WeChat, and Weibo in China, have been applied largely in the field of health promotion and have become the preferred method because of their wide audience and effectiveness in promoting the dissemination of organisational and personal health information [ 9 ]. According to multiple guidelines, family caregivers should be trained on the risk factors for pressure injuries, nutrition, skin assessment, characteristics of pressure injuries, interventions to prevent pressure injuries from occurring, signs and symptoms of complications of pressure injuries (such as infections), and use of protective equipment and devices. Although family caregivers are satisfied with Internet-based guidance and report the benefit of the guidance provided, many platforms and apps are only used sporadically, and their use has decreased over time [ 10 ], which may be due to changes in the tasks assigned to family caregivers. Gaps exist between providers’ information and the needs of family caregivers. The persistently high incidence of pressure injuries and the declining use of various management strategies suggest the need to develop professional care and counselling resources for family caregivers. Limitations This study has several limitations. Firstly, during data collection, we intended to conduct as many family observations as possible. However, these observation sites were limited to a community in Suzhou due to financial constraints. Future studies should be conducted in a variety of geographical settings. Secondly, this is a qualitative study, thus quantitative conclusions cannot be made. Conclusion Eight themes were extracted after analysing the on-site observation records and interviews. These included four topics on care content (food preparation and feeding support, maintaining hygiene, postural change and use of support, use of medication, and dressing), two perception topics (responsible care and compensatory companion, grief, and helplessness), and two challenge topics (identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources). Family caregivers still engage in inappropriate care behaviours, such as in terms of the frequency of body position changes and ways to keep the wound clean and hygienic. The education of family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs and introduce cases for teaching purposes when appropriate. To promote the availability of professional care and counselling resources for pressure injuries, the community can be united to carry out systematic science popularisation by using various effective media such as new media and video channels. Abbreviations CAPI community-acquired pressure injuries WCET World Council Enterostomal Therapists Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Soochow University (No. SUDA20231020H02). Written and signed consent was obtained from the patients and the caregivers. Consent for publication Not applicable. Availability of data and materials The datasets generated and analysed during the current study are not publicly available due to confidentiality requirements but are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by Guangzhou Concord Medical Humanities Research and Education Fund (No. 23000-3050070), and the 11th batch of the Science and Technology Development Plan of Suzhou in 2023 (Basic Research - Medical Application Basic Research; No. SKY2023125). Authors' contributions CY, CKJ, and LY designed the study. LP, ZLJ, CYX, and WLZ conducted the participatory observation and in-depth interviews. CY and CKJ transcribed the interview recordings and coded the data. CY and LY drafted, revised, and critically reviewed the article. All authors read and approved the final manuscript. Acknowledgements We would like to thank Editage (www.editage.cn) for English language editing. Authors' information Chen Yi is a member of the World Council Enterostomal Therapists (WCET) and serves as the secretary of the Society of Wound, Ostomy and Incontinence Nursing in Suzhou. She has worked at Soochow University during the year 2022-2024, and is now studying for her doctorate at Fudan University. References European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel. Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. National Pressure Injury Advisory Panel; 2019. Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052–60. 10.1001/jama.2014.304 . Latimer S, Chaboyer W, Thalib L, McInnes E, Bucknall T, Gillespie BM. Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. J Clin Nurs. 2019;28(21–22):4119–27. 10.1111/jocn.14967 . Rafiei H, Vanaki Z, Mohammadi E, Hosseinzadeh K. The role of family caregivers in pressure injury prevention guidelines: a scoping review. Home Healthc Now. 2021;39(5):253–60. 10.1097/NHH.0000000000001000 . Wang Y, Xu Y, Ma YF, Wang XJ, Yang X, Cao J, et al. A field research based on the best evidence of nursing care for the prevention of deep vein thrombosis after joint replacement. Chin J Nurs. 2021;56(4):521–6. (in Chinese). Sari SP, Everink IH, Sari EA, Afriandi I, Amir Y, Lohrmann C, Halfens RJ, Schols JM. The prevalence of pressure ulcers in community-dwelling older adults: a study in an Indonesian city. Int Wound J. 2019;16(2):534–41. 10.1111/iwj.13081 . Artico M, Dante A, D’angelo D, Lamarca L, Mastroianni C, PetittiT, Piredda M, De Marinis MG. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: a retrospective chart review. Palliat Med. 2018;32:299–307. 10.1177/0269216317737671 . Browning CJ, Qiu Z, Yang H, Zhang T, Thomas SA. Food, eating, and happy aging: the perceptions of older Chinese people. Front Public Health. 2019;7:73. Asghari Amrei S, Ayatollahi H, Salehi SH. A smartphone application for burn self-care. J Burn Care Res. 2020;41(2):384–9. 10.1093/jbcr/irz181 . Egan KJ, Pinto-Bruno ÁC, Bighelli I, Berg-Weger M, van Straten A, Albanese E, Pot AM. Online training and support programs designed to improve mental health and reduce burden among caregivers of people with dementia: a systematic review. J Am Med Dir Assoc. 2018;19(3):200–e61. 10.1016/j.jamda.2017.10.023 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 13 Aug, 2024 Editor assigned by journal 05 Aug, 2024 Submission checks completed at journal 05 Aug, 2024 First submitted to journal 23 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4787002","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":339975788,"identity":"3cb8a3e2-3103-4a99-87d7-0815aea4ff9c","order_by":0,"name":"Yi Chen","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Chen","suffix":""},{"id":339975789,"identity":"e0e29805-0aa7-41ab-bd01-cb8994a6d28a","order_by":1,"name":"Ping Le","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Le","suffix":""},{"id":339975790,"identity":"183c6a17-a72b-4c97-ac49-b225e7dc80da","order_by":2,"name":"Lijuan Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Lijuan","middleName":"","lastName":"Zhang","suffix":""},{"id":339975791,"identity":"31bef84b-32f9-4f85-b8c0-7f4bc2b1823c","order_by":3,"name":"Yunxia Chen","email":"","orcid":"","institution":"The Fourth Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Yunxia","middleName":"","lastName":"Chen","suffix":""},{"id":339975792,"identity":"1805b308-7788-4747-87bd-24bad64ab075","order_by":4,"name":"Linzhu Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Linzhu","middleName":"","lastName":"Wu","suffix":""},{"id":339975793,"identity":"1143df80-4339-44df-bc62-8843ddf516dc","order_by":5,"name":"Kejian Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArklEQVRIiWNgGAWjYFCCBAbGBh4bHn72BtK0pMlI9hwgSQvDYRuDGw5EajA4nmP4cYbMeR6GGwyMHz7mEKPlzBtjyQ08t3kYZzcwS87cRoyWG7nbGB8AtTDLHGBj5iVByzkeNokEUrRs4DnAw0O0Fskz7z9LzuBJ5pHgOdhMnF/4jqclfuztsbO3P9588MNHYrQoHAASjD0gJjB6iALyYHU/iFM8CkbBKBgFIxQAANDqOJZe1fVjAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":true,"prefix":"","firstName":"Kejian","middleName":"","lastName":"Chen","suffix":""},{"id":339975794,"identity":"e721404e-090d-4593-88e5-85903d0fdcac","order_by":6,"name":"Yan Lu","email":"","orcid":"","institution":"The First Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2024-07-23 08:37:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4787002/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4787002/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06114-1","type":"published","date":"2025-07-03T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86179739,"identity":"ef80252d-351f-4d6d-8d75-8aadb324f72c","added_by":"auto","created_at":"2025-07-07 16:19:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1253565,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4787002/v1/5a4ac673-b08d-45c4-a9f4-d08d3984f354.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Family caregivers' perceptions and challenges in the care of pressure injuries in a daily life: a qualitative field study","fulltext":[{"header":"Background","content":"\u003cp\u003ePressure injury refers to local damage to the skin and/or soft tissue caused by pressure or combined shear forces. These often occur in bone prominences but may also be associated with medical or other devices [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Depending on the venue where they occur, they are divided into community-acquired pressure injuries (CAPI) and hospital-acquired pressure injuries. CAPI include pressure injuries that occur in nursing homes and private residences. Internationally, according to the degree of skin and tissue loss, they are usually divided into stages 1 to 4, as well as unstageable pressure injury, and deep tissue pressure injury [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In recent years, with the ageing of society and changes in the disease spectrum, the incidence of pressure injuries remains high and represents a global nursing problem. Patients often experience pain, seepage, odours, and other symptoms that seriously affect their quality of life. Pressure injury patients need family caregivers to provide timely rehabilitation, nutrition, emotional support, and wound dressing changes. Family caregivers often connect patients and nursing professionals, and the level of family caregivers' participation in care plays a key role in patients' wound healing and improving their quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Even if family caregivers play an important role, their lack of knowledge, care skills, early warning and identification ability, and attention to pressure injuries can lead to not only delayed medical treatment but also neglect of long-term care and home management of pressure injury patients, exacerbating the occurrence and development of these injuries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to interpersonal interaction theory/dualistic coping theory, family caregivers and patients support each other, and family caregivers can be sources of stress or providers of positive resources. If family caregivers have better coping and emotional regulation abilities, they will be better able to care for patients with pressure injuries [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Family caregivers deal with the initial occurrence of pressure injuries as stressful events. In many cases, first-time caregivers have no experience and can easily overlook important observation points, which aggravates the progress of pressure injury recovery and delays the best time to turn to professional medical treatment. The following questions need to be addressed. What is the in-practice status of caregivers\u0026rsquo; treatment of initial pressure injuries? What discrepancies exist between the care provided and the care expected by medical teams? What are the warning signs that aggravate or suggest changes in conditions that are easy to miss in this type of care?\u003c/p\u003e \u003cp\u003eTo answer these questions, using field research [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], this project aimed to understand the current situation of caregivers' nursing practice for initial pressure injuries. Through reflection on the current situation, we further explore and identify the discrepancies between the actual care provided to this population group and the methods of prevention and treatment of pressure injuries recommended by the guidelines, as well as the difficulties in practical nursing care for initial pressure injuries. This is of great significance in helping caregivers to recognise, prevent, and provide cooperative treatment of pressure injuries.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn 2023, we conducted a qualitative approach using field research and in-depth semi-structured interviews with caregivers of patients with pressure injuries in Suzhou, China.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and settings\u003c/h2\u003e \u003cp\u003eThe community in which 17 families lived was selected as the field. We selected family caregivers who took care of initial pressure injuries in the field between May and October 2023 as key informants. The following inclusion criteria for caregivers were applied: (1) family caregivers aged at least 18 years; (2) the caregiver provided the most care time and provided the care for the patient\u0026rsquo;s initial pressure injury; (3) the caregiver provided informed consent to participate in the study. Exclusion criteria were those with mental disorders or those unable to communicate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection and methodology\u003c/h2\u003e \u003cp\u003eThe researcher participative observation method was used to collect data. The observation process consisted of three stages: descriptive, focus, and selective observations. When researchers enter a field, they conduct descriptive observations. This involves establishing basic relationships, for example by talking to patients and family members. This stage focuses on describing the workflow of the family caregiver\u0026rsquo;s daily care of the patient and understanding the general situation in the field. Focus observation was conducted after communicating with the caregivers. The observation period was 07:30\u0026ndash;18:30 every day, according to the caregiver\u0026rsquo;s accompanying time. The study focused on prevention and treatment recommendations for \u0026lsquo;populations in the community, the elderly care, and rehabilitation settings\u0026rsquo; in the 2019 Prevention and Treatment of Pressure Ulcers/Injuries developed by the European Pressure Ulcer Advisory Panel [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], including how to prevent pressure injuries (e.g. supports, position changes, use of dressings), nutritional support (e.g. how to provide food), how to assist professional nursing staff to treat pressure injuries. Nursing content outside the observation period was obtained through communication with nurses, doctors, and patients/families. Field shorthand, audio recordings (with the consent of the interviewee), photography, and other methods were used to collect relevant data. According to the saturation degree of the data in the later analysis process, representative nursing cases for the prevention and treatment of pressure injuries were selected, and the interaction process between patients and caregivers and the reaction of caregivers were selectively observed. We carefully depicted the moments and processes observed in vivid detail. The entire observation period lasted for 6 months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe collected data rooted in this context. Within 24 hours after the end of field observation, the researchers combined the collected data and their own memories to compile field notes and recorded their reflections and perceptions of the field research for that day. Through repeated reading of the field notes, the researchers extracted problems from the original materials and reflected on them. In the subsequent field research, repeated observations, continuous thinking, and comparisons were conducted for the problems found.\u003c/p\u003e \u003cp\u003eWork content analysis was conducted using three qualitative research coding methods: open, axial, and selective coding. Open coding was performed by two researchers who repeatedly read the field notes, and the coding process presented the original content of the field notes as much as possible. The third researcher summarised the coding results of the same field notes, recorded the disputed codes, discussed them collectively, and determined them by listening to expert opinions when necessary. For axial coding, one researcher summarised the open coding notes in a centralised manner, and other researchers in the team proposed modification suggestions. To reach an agreement and explain the relevant categories, selective coding involved the collaboration of two researchers to mine and establish relationships between genera to form a core genus that covered all genera. After the preliminary extraction, the original field notes and coding results were submitted to other members of the research team and experts for review and, if necessary, returned to the department of key insiders for verification to improve the credibility of the data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEthics and quality control\u003c/h2\u003e \u003cp\u003e Before conducting the field study, the researcher explained the purpose of the study to the participants, promising that all their speech and behaviour observations were for research analysis only and that their real names would not appear in any of the records. After obtaining the consent of the observed participants and signing the informed consent form, the researcher asked the observed family caregivers to participate in the care of pressure injuries from the perspective of daily life. During the observation process, the researcher did not evaluate or intervene in the observed speech and behaviour. The research group held seminars regularly to discuss progress in this field research. We analysed the problems found in the study and identified the focus of further research to improve the credibility and comprehensiveness of the findings. This study was approved by the Ethics Committee of Soochow University (No. SUDA20231020H02).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the field, family caregivers, and patients\u003c/h2\u003e \u003cp\u003eThis community (the field) is located in the Yangtze River Delta, Taihu Lake Basin, in the centre of Suzhou, a famous historical and cultural city. Suzhou is an important economic, trade, industrial, commercial, and regional distribution centre, and has a home care service workstation and a community healthcare centre.\u003c/p\u003e \u003cp\u003eA total of 17 family caregivers, aged 48\u0026ndash;79 (57.41\u0026thinsp;\u0026plusmn;\u0026thinsp;9.21) years, were interviewed and observed in this study. Most family caregivers had received at least six years of basic education, eight (47.06%) had been educated in primary school or lower level, five (29.41%) in junior high school, and four (23.53%) in senior high school. Fourteen family caregivers were female, including eight daughters (47.06%), three wives (17.65%), two sons (11.76%), one husband (5.88%), and three daughters-in-law (17.65%). The duration of care ranged from 2 to 204 months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of family caregivers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation background\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRelationship with patient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration of care (months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ejunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ehusband\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ejunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esenior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ejunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eprimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ejunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eprimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eprimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eprimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eprimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ejunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esenior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esenior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCG17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esenior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003eThe demographic data of patients with pressure injuries and their characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The patients\u0026rsquo; ages ranged from 68 to 86 (78.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35) years, including 9 female patients. The wound duration ranged from 0.5 to 12 (2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71) months. The pressure injury stages were as follows: stage 4 (30.43%, 7/23), stage 3 (21.74%, 5/23), stage 2 (39.13%, 9/23), and stage 1 (8.70%, 2/23).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of patients with pressure injury and characteristics of pressure injury\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWound duration (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWound size [length (cm)*width (cm)*depth (cm)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStage*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal number of pressure injuries\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6*7*3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7*8*4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5*8,5*2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4*4*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eright ankle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4*5*2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eright heel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3*2*2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2*3*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1*2*0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eright back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2*2*1,7*7*2, 4*4*0.8, 3*4*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (3), 1 (2)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region, right forearm, heels, back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1*1*0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eleft shoulder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3*4*0.1, 1*1*0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2*2*0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eleft hip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2*2*1, 2*4*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7*10*0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esacrococcygeal region\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3*5*1, 1*2*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5*2.7*1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8*3.5*0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eleft foot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: *: stage 1; stage 2; stage 3; stage 4.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e#2 (3): There are three pressure injuries diagnosed as stage 2.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e1 (2): There are two pressure injuries diagnosed as stage 1.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e about here]\u003c/p\u003e \u003cp\u003eEight themes were extracted after analysing the on-site observation records and interviews. These include four topics on care content (food preparation and feeding support, maintaining hygiene, postural change and use of support, use of medication, and dressing), two perception topics (responsible care and compensatory companions, grief, and helplessness), and two challenge topics (identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDiscrepancies between family and professional caregivers in pressure injury care practice\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSub-theme 1: family caregivers are experienced and skilled in food preparation and feeding support while professional caregivers have little time to prepare\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDuring the field observations and interviews with the family caregivers, most were good at and experienced with food preparation. If family caregivers are too busy to prepare food, they arrange for care workers to provide nutritious food (CG16). CG3 carefully prepared different rice cereals, mushy noodles, shredded dried meat, and a wide variety of other foods suitable for P3 to eat every day, and viewed food preparation as extremely important. CG8 also personalised P8\u0026rsquo;s diet: \u0026lsquo;She, since last year, cannot chew, and so our family members will buy some protein powder and brew for her, basically, some vegetable juice, juice, rice paste, and sometimes along with some chicken breast puree, minced meat mixed together as her meals, so as to ensure her nutrition\u0026rsquo;. CG16: \u0026lsquo;In terms of food, we ask our nanny to prepare three meals a day, and I won\u0026rsquo;t let my mom cook or do housework since her diagnosis of chronic obstructive pulmonary disease. You know, she often feels tired and short of breath\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 2: family caregivers must update their standards for choosing cleaning equipment to maintain hygiene\u003c/h2\u003e \u003cp\u003e We found that 47.06% of caregivers (8/17) did not perform skin cleaning in accordance with the guidelines on body care and the use of sanitary paper. For example, we observed inappropriate behaviours such as family caregivers using rough paper to wipe faeces (to save money), using alkaline soap to clean the skin of patients (regardless of weak acid lotion), and using diapers to collect urine for patients who can urinate normally, simply to reduce the workload of care. CG11 would complain to the researchers: \u0026lsquo;We have been using this kind of toilet paper for many years, and none of us had any adverse reactions, why should we switch to wet wipes?\u0026rsquo; CG8 would always make sure that there were enough diapers available, and when not many were left, she would immediately contact other family members by phone and ask them to buy them in advance. However, although P8 had a pressure injury, she was not incontinent and could get out of bed to urinate by herself. The pressure injury to her back was caused by sitting in a wheelchair for too long. CG8 thought that if P8 wore the diaper and sat in a wheelchair, she could deal with other piecemeal housework, such as shopping for food, feeding, and medicine administration, but CG8 had no idea about checking the saturation level of the diaper frequently. CG8 did not change the diaper until the patient\u0026rsquo;s hips became extremely red. The above situation must not be allowed to happen in hospitals or medical and health service units when patients are cared for by professional caregivers.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSub-theme 3: family caregivers have questions about the details of changing positions and using upholder supports (e.g. mattresses)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn daily life, family caregivers are not very clear about the details of position change; most family caregivers just know \u0026lsquo;turn over\u0026rsquo;, but the frequency of turn over, the angle, and the upholders remain unclear. For patients bound to wheelchairs, most family caregivers cannot take timely measures to reduce pressure. Moreover, family caregivers have doubts about the methods of choosing a buttress. When P4 basks in the sun during the day, CG4 will arrange for P4 to sit in the wheelchair and only cover P4\u0026rsquo;s knees with a quilt, and then CG4 will deal with other affairs. CG4: \u0026lsquo;In fact, it is very difficult to calculate when I should do something, especially it is impossible to remember when it is time to change the position of CG4 or reduce the pressure; basically, I will decide to reduce the pressure by my own feeling, or I will ask P4 herself whether she is tired and if there is a need to change the position?\u0026rsquo; CG16: \u0026lsquo;My mother now has bedsores (pressure injuries); I felt a little confused, I do not know what else to do except for turning over for her every day? Someone told me to use air-cushion mattresses, so I quickly bought one online. Is there any other better option for pressure redistribution?\u0026rsquo; CG9: \u0026lsquo;You know, P9 has so many pressure injuries; I use some pillows, as well as my own handmade, stuffed some spongy cushions, so that she may be more comfortable\u0026rsquo;. CG7: \u0026lsquo;In our home setting, we have never considered a mattress in the prevention or treatment of pressure injuries; actually, I do not know where to find a professional, suitable mattress for her?\u0026rsquo;\u003c/p\u003e \u003cp\u003e \u003cem\u003eSub-theme 4: Family caregivers have access to a wide range of drugs and dressings for the prevention and treatment of pressure injuries, but most neglect decompression dressings\u003c/em\u003e \u003c/p\u003e \u003cp\u003eNon-medical professionals are less aware of the types of medical dressings available. In the home setting, they often obtain medicinal extracts, powders, and dressings for the prevention and treatment of pressure injuries from pharmacies, friends, and neighbours, but often ignore the role of decompression dressings. For example, CG17: \u0026lsquo;We have heard that a special kind of powder can work, so, once there is a little break on his butt, I will sprinkle it on him; initially, it did work, but now the wound is larger, I can't control it, and it is useless to sprinkle the powder. I went to community health services where there were no recommended ointments\u0026rsquo;. CG10: \u0026lsquo;I have been a live-in nanny for many years, and I have met two aged persons with pressure injuries on their buttocks, both of which were coated with golden cream (a kind of Chinese ointment) I bought, so when I was taking care of P10, I was very experienced and shared with the families that I had used dressings that I thought were very good\u0026rsquo; (CG10's face showed a smug expression). \u0026lsquo;However, some inexperienced family caregivers also become confused\u0026rsquo;.\u003c/p\u003e \u003cp\u003eCG1: \u0026lsquo;In the aspect of pressure injury treatment, I feel very confused, because bringing older adults to the hospital is really time-consuming and troublesome. You know, she has now basically lost the ability to move; firstly, we not only have to gather relatives with a car to the hospital but also find family caregivers whose bodies are strong and lusty to transfer her. Above all, one of the family caregivers must be able to communicate with the doctor. Therefore, we may go to the hospital once or twice, and then according to the doctor's guidance, our family members take turns to change her dressings (of course, I am the primary caregiver; others dare not change the wound dressings). If there is no time to go to the hospital, I will take photos of her wounds to show the doctor, but I go to many hospitals; for my mother's pressure injuries, different hospitals may prescribe different medicines/dressings. Some were poultices, some were dressings, so in just two months, our family bought different kinds of drugs and dressings, but I didn't feel that they made her pressure injury any better\u0026rsquo;. In the field observation, we found that most caregivers held the opinion that the wounds needed to be ventilated, kept dry, and did not want to wrap too many dressings, such as some occlusive dressings. The researchers involved in the study suggested that family caregivers could use decompression dressings; however, in many cases, caregivers rejected them because of the high frequency of dressing changes, the cost burden to the family, and the potential impact on wound permeability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePsychological perception of family caregivers participating in pressure injury nursing practice\u003c/h2\u003e \u003cp\u003eThe psychological processes of family caregivers involved in pressure injury nursing care are complex and contradictory. The target population who needs family caregivers to participate in the nursing practice of preventing and treating pressure injuries is often disabled, and disabled people need not only the help of family caregivers in physical care and daily life care but also more love and companionship from family caregivers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 1: responsible care and compensatory companionship\u003c/h2\u003e \u003cp\u003e CG16: \u0026lsquo;My brother is a businessman; my mother used to follow my brother to cities all over the country, and my mother took care of my brother\u0026rsquo;s family at that time. I didn't have enough time to do my duty to take care of my parents before, and now that I'm retired and free, I picked them up and did my best to take care of them. Sadly, in recent years, my parents have not been very well, and I took care of them, which can be regarded as my filial piety\u0026rsquo;. CG6: \u0026lsquo;Well, this year, I have been to the hospital many times, and the patient has been hospitalised twice, and I asked the doctor a lot about his primary diseases, he has been unable to eat, and every child shift in queue to accompany him, there is nothing to do but stay there with him\u0026rsquo;. CG5: \u0026lsquo;When someone in your family is sick, what can you do but directly face it? My husband is the only child; he is very busy, and I have to take care of my mother-in-law out of my responsibility. My mother-in-law has been very helpful to our family, and my children were brought up by my mother-in-law and my father-in-law, and I am so grateful to them, and I should do something to help them when they need it in return\u0026rsquo;. In families with close relationships, family caregivers of patients with pressure injuries may devote more effort to providing emotional support, time, and economic expenditure. We observed that if there are multiple children in a family, patients and caregivers are closer to each other, and visits are usually more frequent. A filial family caregiver was even resigned to accompanying the patient, taking care of her grandmother day and night, while she strictly followed the frequency of turn over every two hours, complying with the medical staff\u0026rsquo;s order. Most of the psychological perceptions of family caregivers participating in the nursing practice of pressure injuries are shouldered with responsibility, and they feel the need to provide compensatory and grateful care to repay the nurturing grace of their relatives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 2: grief and helplessness\u003c/h2\u003e \u003cp\u003eIn the practice of caring for pressure injuries involving caregivers in many family roles, sadness, reluctance, anxiety, and helplessness were identified. CG15: \u0026lsquo;My dad has been lying in bed for a long time due to illness. Last month, he went to the hospital because of ascites, but the doctors said there were no good treatment methods, so he went home without any other treatment. As his children, we took turns taking care of him. *Sigh* (with eyes turning red), the problem (pressure injury) appeared half a month ago; at first, we went to the health clinic and bought the ointment by following the doctor\u0026rsquo;s advice. Whatever, his life is about to end. Luckily, I have plenty of time these days. I will do my best to take care of him, after all, I have only one dad...\u0026rsquo; CG3: \u0026lsquo;At first, I found his skin red and slightly damaged, I thought it was just a scratch. I squeezed some scald cream onto the wound, but I didn't search for multiple treatments. One night later, I didn't expect it to worsen but it did happen. His skin turned black and hard, which scared us. I didn\u0026rsquo;t know what to do. I called the community health service centre, and they asked us to visit the tertiary hospital quickly. As a result, I went to the hospital and wandered around, mistakenly calling the wrong consultation room. I was in a hurry, without anyone guiding me, feeling very powerless and helpless\u0026rsquo;. We found that CG2 often took diligent care of P2, reducing the pressure frequently, putting cushions on him, and chatting with him. As he talks, he gradually becomes silent, conveying a heavy emotional response, especially when he helps P4 change his dressings and sees P4's wound. He gently touches P4's head, asks her to hold on for a while, and soon changes the dressings by himself. He also blames himself for not taking good care of P4, which caused the pressure injury.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eExploring the difficulties of family caregivers in pressure injury care practice\u003c/h2\u003e \u003cp\u003eThe family caregivers are not professional caregivers. After on-site observation of these 17 family caregivers and patients, they also faced two major difficulties in pressure injury care practice: identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 1: identifying and alerting barriers to pressure injury\u003c/h2\u003e \u003cp\u003eSeventeen family caregivers mentioned more than once that the patient had little red spots, erythema, and they did not take it seriously, and later it gradually developed into a pressure injury, or several family caregivers thought that it may be eczema and that it was good to blow it and keep the affected area dry. CG9 mentioned: \u0026lsquo;I am very good at recognising pressure injuries, and every time I remind P9\u0026rsquo;s other family members that there is redness in this area, we should pay attention to it, and sprinkle some baby powder to keep her place dry, so that it will not worsen\u0026rsquo;. However, CG9 was overconfident; her measures were not in line with practice guidelines, and the warning signs she mentioned were not comprehensive. CG13 believed that her husband was allergic and that his skin was sensitive; therefore, he often showed redness. CG7 expressed regret for not recognising and treating her earlier: \u0026lsquo;Oh, I was too busy a few days ago, the times I went home decreased, and then when one day I came back to turn her over, I suddenly found this wound; hey, if I had found it earlier, it would have been easier to treat the wound and promote her wound healing faster\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme 2: shortage of professional care and counselling resources\u003c/h2\u003e \u003cp\u003eOf the 17 family caregivers, 58.82% indicated that their patients had no access to professional knowledge or resources since the pressure injury occurred. This suggests the need to strengthen science popularisation resources in the community and increase professional care and consultation resources. CG5: \u0026lsquo;I wish I knew the consultation resources and treatment procedures earlier, so that it may not take too long to go to the doctor\u0026rsquo;. CG16: \u0026lsquo;My mother has Parkinson's disease, her respiratory system is not very good, she always has dyspnoea when she walks for several metres, her lumbar spine is not very good, and she has a hunchback, which cannot withstand the hospital tossing back and forth; if someone comes to the house, or I can get care resources anytime and anywhere, it is very beneficial for me. It is best to have a professional caregiver set up a consultation point at the community health service centre in front of my home because it is close, and I can run to ask questions about pressure injury timely, furthermore, I can save my precious time to improve the work efficiency\u0026rsquo;.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cb\u003eWhen family caregivers participate in pressure injury care practice, they still perform inappropriate caring procedures (e.g. frequency of postural change and keeping the wound clean and hygienic)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAn Indonesian study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] confirmed that almost no CAPI patients were cared for by family caregivers prior to hospitalisation, despite living with family members and other relatives, and that effective cooperation and involvement of family caregivers in the treatment of PI directly increased the likelihood of recovery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], although this possibility has not been supported by longitudinal studies. Mastering the caregiving skills associated with pressure injuries is mostly the responsibility of the family caregiver. Lack of attention to the role of family caregivers can lead to poor knowledge and ability of family caregivers to prevent pressure injuries, which in turn may increase the chances of patients developing pressure injuries. Rafiei et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] advocated that family caregivers should be involved in the care of patients with pressure injuries, and strategies for improving the skills of caregivers should be investigated further. In the field investigation of family caregivers in this study, most family caregivers could complete basic daily care content, especially diet, which is probably in accordance with the Chinese culture of \u0026lsquo;food is people's foremost/primary concern\u0026rsquo; [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It seems that in daily life, family caregivers are mainly responsible for providing food. The food they provide to patients is sufficient, nutritious, and diverse. However, the study found that the shortcomings of family caregivers' care lie in the frequency of changes in body position and the lack of methods to maintain cleanliness and hygiene. In the eyes of family caregivers, patients are still considered normal people and are not treated as vulnerable people with damaged skin barriers. Ways to reduce pressure and clean the skin of people with disabilities are often overlooked.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEducation for family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA British study [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] confirmed that 81% of patients with pressure injuries lived at home before admission and ignoring the early warning signs of pressure injuries led to declines in quality of life. Once pressure injuries occur, the wound healing cycle becomes too long to predict the prognosis. This field study also found that most family caregivers may miss early warning signs, and the likelihood of systemic infection will be reduced; if the pressure injury is not so severe as to reach stages 3 and 4, its treatment duration and economic expenditure can be reduced. Therefore, \u0026lsquo;prevention is better than treatment\u0026rsquo;, and education for family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs. Currently, China is becoming an ageing society, and most current family caregivers are middle-aged or older. Therefore, education should be conducted in a simple and understandable form, and real cases can be incorporated into health education, to attract audience interest.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTo promote the availability of professional care and counselling resources for pressure injuries, the community can play an important role in conducting science popularisation using various effective media\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs society enters an era of advanced ageing, pressure injuries, a common complication, have attracted the attention of researchers. In China, where families have traditionally been involved in the care of older adults and those with chronic disease, the following question arises: how can communities be utilised to keep disabled family members at home for as long as possible for long-term home care? It is vital to use effective media to conduct science popularisation activities to facilitate access to professional care and counselling resources for pressure injuries.\u003c/p\u003e \u003cp\u003eSocial media, including websites, forums, WeChat, and Weibo in China, have been applied largely in the field of health promotion and have become the preferred method because of their wide audience and effectiveness in promoting the dissemination of organisational and personal health information [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. According to multiple guidelines, family caregivers should be trained on the risk factors for pressure injuries, nutrition, skin assessment, characteristics of pressure injuries, interventions to prevent pressure injuries from occurring, signs and symptoms of complications of pressure injuries (such as infections), and use of protective equipment and devices. Although family caregivers are satisfied with Internet-based guidance and report the benefit of the guidance provided, many platforms and apps are only used sporadically, and their use has decreased over time [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which may be due to changes in the tasks assigned to family caregivers. Gaps exist between providers\u0026rsquo; information and the needs of family caregivers. The persistently high incidence of pressure injuries and the declining use of various management strategies suggest the need to develop professional care and counselling resources for family caregivers.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. Firstly, during data collection, we intended to conduct as many family observations as possible. However, these observation sites were limited to a community in Suzhou due to financial constraints. Future studies should be conducted in a variety of geographical settings. Secondly, this is a qualitative study, thus quantitative conclusions cannot be made.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEight themes were extracted after analysing the on-site observation records and interviews. These included four topics on care content (food preparation and feeding support, maintaining hygiene, postural change and use of support, use of medication, and dressing), two perception topics (responsible care and compensatory companion, grief, and helplessness), and two challenge topics (identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources). Family caregivers still engage in inappropriate care behaviours, such as in terms of the frequency of body position changes and ways to keep the wound clean and hygienic. The education of family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs and introduce cases for teaching purposes when appropriate. To promote the availability of professional care and counselling resources for pressure injuries, the community can be united to carry out systematic science popularisation by using various effective media such as new media and video channels.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAPI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecommunity-acquired pressure injuries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWCET\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Council Enterostomal Therapists\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Soochow University (No. SUDA20231020H02).\u0026nbsp;Written and signed consent was obtained from the patients and the caregivers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due to confidentiality requirements but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Guangzhou Concord Medical Humanities Research and Education Fund (No. 23000-3050070), and the 11th batch of the Science and Technology Development Plan of Suzhou in 2023 (Basic Research - Medical Application Basic Research; No. SKY2023125).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCY, CKJ, and LY designed the study. LP, ZLJ, CYX, and WLZ conducted the participatory observation and in-depth interviews. CY and CKJ transcribed the interview recordings and coded the data. CY and LY drafted, revised, and critically reviewed the article. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.cn) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChen Yi is a member of the World Council Enterostomal Therapists (WCET) and serves as the secretary of the Society of Wound, Ostomy and Incontinence Nursing in Suzhou. She has worked at Soochow University during the year 2022-2024, and is now studying for her doctorate at Fudan University.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEuropean Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel. Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. National Pressure Injury Advisory Panel; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden: a clinical review. JAMA. 2014;311(10):1052\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2014.304\u003c/span\u003e\u003cspan address=\"10.1001/jama.2014.304\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLatimer S, Chaboyer W, Thalib L, McInnes E, Bucknall T, Gillespie BM. Pressure injury prevalence and predictors among older adults in the first 36 hours of hospitalisation. J Clin Nurs. 2019;28(21\u0026ndash;22):4119\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jocn.14967\u003c/span\u003e\u003cspan address=\"10.1111/jocn.14967\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRafiei H, Vanaki Z, Mohammadi E, Hosseinzadeh K. The role of family caregivers in pressure injury prevention guidelines: a scoping review. Home Healthc Now. 2021;39(5):253\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/NHH.0000000000001000\u003c/span\u003e\u003cspan address=\"10.1097/NHH.0000000000001000\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Xu Y, Ma YF, Wang XJ, Yang X, Cao J, et al. A field research based on the best evidence of nursing care for the prevention of deep vein thrombosis after joint replacement. Chin J Nurs. 2021;56(4):521\u0026ndash;6. (in Chinese).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSari SP, Everink IH, Sari EA, Afriandi I, Amir Y, Lohrmann C, Halfens RJ, Schols JM. The prevalence of pressure ulcers in community-dwelling older adults: a study in an Indonesian city. Int Wound J. 2019;16(2):534\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/iwj.13081\u003c/span\u003e\u003cspan address=\"10.1111/iwj.13081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArtico M, Dante A, D\u0026rsquo;angelo D, Lamarca L, Mastroianni C, PetittiT, Piredda M, De Marinis MG. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: a retrospective chart review. Palliat Med. 2018;32:299\u0026ndash;307. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0269216317737671\u003c/span\u003e\u003cspan address=\"10.1177/0269216317737671\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrowning CJ, Qiu Z, Yang H, Zhang T, Thomas SA. Food, eating, and happy aging: the perceptions of older Chinese people. Front Public Health. 2019;7:73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsghari Amrei S, Ayatollahi H, Salehi SH. A smartphone application for burn self-care. J Burn Care Res. 2020;41(2):384\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jbcr/irz181\u003c/span\u003e\u003cspan address=\"10.1093/jbcr/irz181\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgan KJ, Pinto-Bruno \u0026Aacute;C, Bighelli I, Berg-Weger M, van Straten A, Albanese E, Pot AM. Online training and support programs designed to improve mental health and reduce burden among caregivers of people with dementia: a systematic review. J Am Med Dir Assoc. 2018;19(3):200\u0026ndash;e61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2017.10.023\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2017.10.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pressure injury, Family caregivers, Daily life, Challenge, Field research","lastPublishedDoi":"10.21203/rs.3.rs-4787002/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4787002/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjectives: This study aimed to understand existing discrepancies between primary pressure injury care in daily practice and care as recommended by medical professionals (identification, prevention, and treatment), psychological perceptions of family caregivers' participation in pressure injury care practice, and the difficulties faced by family caregivers in performing pressure injury care. Therefore, key coping strategies for caregivers in the practice of identifying, preventing, and cooperating with the treatment of pressure injuries were proposed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: From June to December 2023, 17 older patients with pressure injuries were observed and 17 family caregivers were interviewed using a field study design that included semi-participatory observation and in-depth interviews. Field notes were analysed using a qualitative three-level coding method.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Eight themes were extracted after analysing the on-site observation records and interviews. These included four topics on care content (food preparation and feeding support, maintaining hygiene, postural change and use of supports, use of medication, and dressing), two perception topics (responsible care and compensatory companion, grief, and helplessness), and two challengetopics (identifying and alerting barriers to pressure injury and shortage of professional care and counselling resources).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Family caregivers still provide inappropriate pressure injury care, for example, in terms of frequency of body position changes and ways to keep wounds clean and hygienic. The education of family caregivers of disabled older adults should include the identification of pressure injuries and related early warning signs and introduce teaching cases when appropriate. To facilitate access to professional care and counselling resources for pressure injuries, the community can be united to carry out systematic science popularisation by using various effective media such as new media and video channels.\u003c/p\u003e","manuscriptTitle":"Family caregivers' perceptions and challenges in the care of pressure injuries in a daily life: a qualitative field study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-30 10:31:28","doi":"10.21203/rs.3.rs-4787002/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-14T02:40:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-05T07:49:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-05T07:48:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-07-23T08:35:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b580ad4-8f34-41a8-a847-de073e58cddd","owner":[],"postedDate":"August 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:11:25+00:00","versionOfRecord":{"articleIdentity":"rs-4787002","link":"https://doi.org/10.1186/s12877-025-06114-1","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-07-03 15:57:58","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2024-08-30 10:31:28","video":"","vorDoi":"10.1186/s12877-025-06114-1","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06114-1","workflowStages":[]},"version":"v1","identity":"rs-4787002","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4787002","identity":"rs-4787002","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}