Nursing Home Nursing Staff Perspective About Using Subepidermal Moisture Technology for Pressure Injury Prevention

Pressure injuries (PrIs) represent a persistent challenge in nursing homes, with facility-acquired rates of 8.5%. Subepidermal moisture (SEM) technology offers promise for early detection across all skin tones, yet remains underadopted in nursing home environments.

This qualitative study examined nursing home staff perceptions of SEM technology implementation using Rogers's Diffusion of Innovation theoretical framework to understand the overall adoption process.

Seven focus groups were conducted across 5 nursing homes with 50 staff members (registered nurses, licensed practical nurses, and certified nursing assistants) who had used SEM equipment during an 8-month intervention. Two facilities participated in temporal assessments at months 1 and 8. A directed qualitative content analysis was performed using 6 a priori codes derived from Diffusion of Innovation theory: observability, trialability, compatibility, relative advantage, and complexity.

Analysis of 80 unique participant quotes yielded 132 coded instances across innovation characteristics. Notably, 68% of coded examples reflected negative perceptions of the technology, contrasting sharply with typical health care innovation adoption patterns. Key barriers included poor compatibility with existing workflows (35% of instances), implementation complexity extending beyond device operation (31%), mixed observability of benefits (32%), and concerns about relative advantage amid resource constraints (26%). Technology inflexibility prevented error correction and workflow adaptation (25%), whereas sustainability concerns emerged regarding long-term viability (17%). Temporal assessment revealed declining enthusiasm and compliance rates over the intervention period.

Despite SEM technology's clinical potential, significant implementation barriers hindered adoption in resource-constrained nursing home environments. Findings highlight the critical importance of addressing workflow integration, organizational context, and staff burden when implementing health care innovations. Future implementation strategies must explicitly address resource constraints and develop comprehensive support systems that minimize workflow disruption while maintaining technology effectiveness.