# Barriers to pressure injury prevention and associated factors among critical care nurses in Malaysia

## TL;DR

This study identifies key barriers to preventing pressure injuries in Malaysian critical care units, including staff turnover and lack of resources.

## Contribution

The study provides insights into specific barriers and associated factors among critical care nurses in Malaysia, offering actionable recommendations for improvement.

## Key findings

- Frequent staff turnover was the highest barrier to pressure injury prevention.
- Poor cooperation from family caregivers and lack of preventive devices were major barriers.
- Restricted access to guidelines was a significant predictor of perceived barriers.

## Abstract

Pressure injury (PI) remains a major patient safety concern in intensive care, where immobility, high acuity, and workload increase risk. Although guidelines exist, prevention practices in Malaysian tertiary hospitals are inconsistent. Understanding perceived barriers and associated factors among critical care nurses is essential for targeted interventions.

A cross-sectional study was conducted among registered nurses in ICUs, NICUs, PICUs, HDUs, and CCUs across three tertiary hospitals in Perak, Malaysia. Stratified random sampling proportionate to hospital and unit size selected 384 nurses, of which 347 completed the survey (response rate 90.4%). Data were collected using a validated 25-item Pressure Injury Prevention Barriers (PIPB) questionnaire (Cronbach’s α = 0.90). Descriptive statistics summarized characteristics and barrier scores, while logistic regression identified factors associated with high perceived barriers (p < 0.05).

Barriers to PI prevention were highly prevalent. The main barriers were frequent staff turnover (score = 99), poor cooperation from family caregivers (84), and lack of preventive devices (71). Multivariate analysis indicated that staff turnover, limited caregiver cooperation, and restricted access to guidelines were the strongest predictors of perceived barriers.

PI prevention in Malaysian critical care units is hampered by staff turnover, limited caregiver cooperation, equipment shortages, and uneven access to guidelines. Strengthening guideline dissemination, retention policies, resource provision, and multidisciplinary engagement is vital to improve patient safety.

The online version contains supplementary material available at 10.1186/s12912-025-03963-4.