Exploring nursing assistants’ competencies in pressure injury prevention and management in nursing homes: a qualitative study using the iceberg model

Background: As the global population ages rapidly, pressure injuries (PI) in nursing homes have become a serious health concern. Nursing assistants play an important role in pressure injury prevention and management (PIPM). Objective: This study aimed to explore the PIPM competencies required by nursing assistants within nursing homes based on the Iceberg Model. Methods: We employed a qualitative descriptive study and collected data through a focus group with 12 nursing assistants and semi-structured interviews with 11 key stakeholders in China. Deductive content analysis was utilized based on the Iceberg Model. Results: Five main categories of nursing assistants’ PIPM competencies were identified: theoretical knowledge, comprehensive skills, self-concept, traits, and motives. Theoretical knowledge included PI basic and professional theoretical knowledge, emphasizing the importance of understanding PI mechanisms, risk factors, and prevention strategies. Comprehensive skills encompassed practical skills (e.g., repositioning techniques, wound care), communication skills, collaboration skills, and observation skills. Self-concept involves professional identity, ethical awareness, and a sense of responsibility. Traits included carefulness and love, and empathy and patience. Motives were driven by professional development opportunities and supportive institutional policies. Conclusion: The application of the Iceberg Model enhanced the understanding of competencies required for effective PIPM. The findings can guide the development of targeted training programs and assessment tools for nursing assistants in long-term care facilities. Future research should explore the long-term impacts of well-trained nursing assistants on patient outcomes and expand the PIPM competencies scope required by nursing assistants. Clinical trial number: Not applicable.