Nurses’ perceptions of potentially low-value care in pressure injury management: a mixed-methods study

Pressure injury is a key nursing-sensitive quality indicator associated with substantial patient morbidity, mortality, and global healthcare costs. While potentially low-value care in pressure injury management may divert clinical resources from higher-value interventions, limited research has explored such practices from the perspective of frontline nurses, particularly regarding their perceived workload burden and clinical challenges. This mixed-methods study aimed to characterize nurses’ perceptions of potentially low-value pressure injury practices and explore their underlying experiences and improvement needs in ICU settings. A sequential explanatory mixed-methods study was conducted from April 2025 to April 2026. In the quantitative component, a self-developed exploratory questionnaire was administered to 43 critical care specialist nurse trainees from 39 hospitals across 18 provinces in China to assess perceived burden scores for pressure injury-related nursing tasks and identify practices perceived as potentially unnecessary. Perceived burden was rated on a 0–10 scale. Participants also selected and ranked up to five practices they considered most unnecessary, and a reverse Borda count was used to summarize the rankings. Subsequently, 12 frontline critical care nurses participated in semi-structured interviews. Qualitative data were analyzed using inductive thematic analysis, and quantitative and qualitative findings were integrated during interpretation. Among the 43 participants, wound care had the highest perceived burden score (median = 6.0, IQR = 3.5). Repositioning, nutrition management, pressure injury reporting, and health education each had a median perceived burden score of 5.0. In the ranking task, establishment of repositioning record cards was the practice most frequently perceived as potentially unnecessary, selected by 35 of 43 participants (81.40%), including 20 (46.51%) who ranked it first. Qualitative analysis identified three themes and 11 subthemes: perceived manifestations of potentially low-value pressure injury practices; perceived consequences of pressure injury-related practices; and recommendations for optimizing pressure injury management. Participants particularly described redundant documentation, rigid standardized processes, defensive accountability, inefficient information management, and routine resource use as sources of burden. Integration of the findings suggested that perceptions of potentially low-value care may relate less to the interventions themselves than to rigid, repetitive, and insufficiently individualized implementation. Frontline critical care nurses perceived substantial burden associated with several pressure injury-related practices and identified some practices as potentially unnecessary. These perceptions were associated with repetitive documentation, rigid standardized processes, defensive accountability, and resource use that was insufficiently individualized. The findings should not be interpreted as evidence that the identified practices are objectively low-value. Further research using objective workload indicators, clinical outcomes, and multiple stakeholder perspectives is needed to evaluate the clinical value and appropriateness of these practices and identify opportunities for evidence-based optimization.