Jun 20, 2025
Exploring Evidence for Family Involvement in Pressure Injury Prevention: A Scoping Review
- Mangai Joseph Mafuyai1,
- Ntombifikile Klaas2,
- Irene Kearns2
- 1University of Jos, Faculty of Health Sciences and Technology;
- 2Department of Nursing Education, University of the Witwatersrand, Faculty of Health Sciences, School of Therapeutic Sciences
- Scoping Review
Protocol Citation: Mangai Joseph Mafuyai, Ntombifikile Klaas, Irene Kearns 2025. Exploring Evidence for Family Involvement in Pressure Injury Prevention: A Scoping Review. protocols.io https://dx.doi.org/10.17504/protocols.io.x54v9o9ezv3e/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: June 20, 2025
Last Modified: June 20, 2025
Protocol Integer ID: 220622
Keywords: family involvement in the prevention, pressure injury prevention, pressure injuries in adult acute, evidence for family involvement, current evidence on family involvement, pressure injury, family involvement, regarding family involvement, potential for family involvement, early prevention, home care setting, family, clinical practice, development of family, prevention strategy, scoping review methodology, prevention, centred prevention strategy, scoping review, scoping review despite advancement, challenges for patient, included study, patient
Abstract
Despite advancements in pressure injury prevention, their prevalence remains a significant global concern, posing challenges for patients and their families, particularly in the home setting. Recognizing the potential for family involvement in early prevention, this scoping review seeks to map the existing evidence on this crucial aspect of care. This scoping review will systematically map and characterize the available evidence regarding family involvement in the prevention of pressure injuries in adult acute and home care settings. A scoping review methodology, guided by the Joanna Briggs Institute framework, will be employed. A systematic search will be conducted across PubMed, Scopus, ProQuest, Medline, and CINAHL databases using predefined search strategies. Two independent reviewers will screen titles, abstracts, and full texts against established eligibility criteria. Data from included studies will be extracted, categorized, and synthesized narratively to identify key themes and insights. This scoping review is expected to synthesize the current evidence on family involvement in pressure injury prevention, thereby informing the development of family-centred prevention strategies and highlighting areas for future research and clinical practice.
Guidelines
While nurses bear the primary responsibility for pressure injury prevention, engaging patients and their families in multi-disciplinary strategies is crucial to reducing this significant healthcare burden. Pressure injuries not only complicate hospital stays but also pose substantial challenges and economic strain on patients and their families post-discharge, particularly for vulnerable populations. The financial impact is considerable, costing healthcare systems billions annually and contributing to increased patient suffering, prolonged hospitalizations, and diminished quality of life, even leading to fatal infections. High prevalence rates, such as the 57% reported in northern Nigeria, further underscore the urgency of effective prevention strategies. Despite nurses' pivotal role in education and prevention, barriers like understaffing and resource limitations hinder their efforts. The evolution towards family-centred care (FCC), recognizing families as integral partners in the healthcare team, presents a significant opportunity to enhance pressure injury prevention. This partnership acknowledges that family members, often the primary caregivers, can significantly influence prevention, especially for older adults at home. In fact, studies suggest that empowering families could substantially reduce pressure injury prevalence. However, family caregivers often report a lack of education and specific programs to support their involvement. Although family involvement in healthcare decision-making is recognized, particularly in African communities, and their potential to enhance pressure injury prevention is acknowledged, the specific role and extent of their involvement remain poorly defined, especially within the Nigerian context. Existing literature on pressure injury prevention and quality improvement often lacks a clear specification of the family's role. While some research touches on caregiver training and home-based care, comprehensive reviews specifically examining the evidence for family involvement in pressure injury prevention are scarce, and prior reviews have limitations in scope or currency. A Spanish research team also highlighted the importance of family involvement, noting that patients are often primarily cared for by family members, yet their role in healthcare remains poorly defined. This underscores the critical need for a thorough review of existing evidence on family involvement in pressure injury prevention, examining the nature and potential impact of this involvement on pressure injury prevalence. Recognizing the potential for family engagement to improve pressure injury prevention and address the existing gap in synthesized evidence, this scoping review aims to systematically explore the available literature on family involvement in preventing pressure injuries. Specifically, it will identify the nature and extent of family involvement, effective strategies, potential barriers, and facilitators for family participation in pressure injury prevention within adult acute and home care settings, thereby contributing to enhanced patient care and advancing nursing practice.
Review Objectives
This review aims to explore the existing evidence on family involvement in the prevention of pressure injuries, specifically to:
Identify the nature and extent of family involvement in pressure injury prevention.
Explore effective strategies for reducing pressure injuries through family participation.
Identify potential barriers and facilitators for family participation in pressure injury prevention.
Describe outcomes associated with family involvement in pressure injury prevention.
Methods
This scoping review will adhere to the Joanna Briggs Institute (JBI) guidelines for scoping reviews, encompassing the following seven stages:
Defining the research question.
Developing the protocol.
Applying the PCC (Population/Concept/Context) framework.
Conducting systematic searches.
Screening studies.
Extracting and charting relevant data.
Synthesizing and reporting the evidence.
The protocol is registered with the Open Science Framework. This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and will be reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Covidence software and Microsoft Excel will be used to facilitate the screening and data extraction processes.
Review Question
The research question guiding this review is: "What is the research evidence on family involvement in pressure injury prevention?" This scoping review aims to synthesize evidence related to family involvement in pressure injury prevention.
Search Strategy
A three-step search strategy, as recommended by JBI, will be employed. An initial search of PubMed will be conducted to identify key terms related to family involvement and pressure injury prevention. The resulting keywords and index terms will be used to develop a comprehensive search strategy, which will be adapted for other databases using specific thesaurus terms and controlled vocabularies where appropriate. The detailed PubMed search strategy is presented in Table 1.
The search strategy will be implemented across PubMed, ProQuest, Scopus, CINAHL, and Medline. Additionally, the reference lists of included studies will be searched to identify further relevant articles.
Eligibility Criteria
The inclusion criteria, based on the PCC framework, are as follows:
Population: Adult family members providing support to patients at risk of or with pressure injuries.
Concept: Family involvement in pressure injury prevention.
Context: Home-based and acute care settings.
Evidence Source Types: Peer-reviewed, full-text research articles (qualitative, quantitative, and mixed-methods designs) from any country.
Exclusion criteria are duplicate publications, articles with incomplete data, literature reviews, case reports, experimental protocols, opinions, and articles not in English.
Data Selection
Retrieved articles will be uploaded to Covidence for screening. Two independent reviewers will screen titles and abstracts, followed by full-text review, to determine eligibility based on the inclusion criteria. Discrepancies will be resolved through discussion or consultation with a third reviewer. The screening process will be documented using a PRISMA flow diagram.
Data Extraction
Two independent reviewers will extract data from the selected articles using a standardized form in Microsoft Excel. The form will include fields for author, publication year, journal, study objectives, setting, study design, sample characteristics, prevalence and assessment of pressure injuries, factors influencing family involvement, interventions, and outcomes. The data extraction form will be iteratively refined during the data selection process.
Data Synthesis
Data synthesis will employ a rigorous, systematic approach integrating both quantitative and qualitative analyses. Quantitative data will be summarized using descriptive statistics, including the mean, median, standard deviation, and range, to describe the evidence of family involvement in pressure injury prevention across the included studies. Tabular presentation will be used to illustrate family involvement, assessment methodologies, and associated factors.
Qualitative data will be analysed using content analysis with systematic coding to identify key themes and patterns. This approach will explore the contextual and nuanced dimensions of family involvement, including its determinants and impacts. The integration of statistical trends with qualitative insights will provide a comprehensive framework and a nuanced understanding of pressure injury prevention, its determinants, and its consequences, with qualitative findings enriching the interpretation of quantitative summaries.
Ethics Considerations
Although scoping reviews typically do not require formal ethical approval as they exclusively utilize published data, ethical approval for this specific review has been obtained from the Research Ethics Committee, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (Ethical Clearance Certificate No. M250160). The findings of this study will be disseminated through academic publications and conference presentations.
Limitations
This review has several limitations. Firstly, it will not assess the methodological rigor of the included studies. The review is limited to articles published in English, potentially excluding relevant studies published in other languages. Additionally, only peer-reviewed, full-text research articles will be included, and gray literature and articles lacking sufficient detail will be excluded.
Discussion and Conclusion
This scoping review is anticipated to synthesize and strengthen the evidence regarding family involvement in pressure injury prevention. Strengths of this scoping review include the inclusion of studies from all levels of healthcare (primary, secondary, and tertiary), consultation with experts, and the inclusion of educational programs. Despite the stated limitations, this review is, to our knowledge, the first scoping review to comprehensively map concepts relevant to family involvement in pressure injury prevention, setting it apart from prior reviews with limited scope or currency. The results of this review will be valuable for relevant stakeholders seeking to improve family member involvement in pressure injury prevention practices. The findings will also highlight gaps in the research related to pressure injury prevention information. The insights from this review will offer crucial information for healthcare policymakers and administrators aiming to enhance strategies and develop targeted interventions to promote family member involvement in pressure injury prevention.