Your right about one thing, the key to preventing pressure ulcers is education, all involved in care processes from care assistants to managers need to be well versed in this subject. Throughout your research you will have ascertained that pressure ulcers are 95% preventable. With adequate pressure relieving surfaces, frequent repositioning, good nutrition and hydration, hygiene and generally good nursing care, they can be prevented. However, you must also think of that 5% that are not preventable. The skin is the body's largest organ and also one of its most active. In terminal care, we accept that patients could go into renal failure or heart failure etc. If these organs can 'fail', why can't the skin? You also need to acknowledge the presence of existing co-pathologies. In a healthcare setting, the patients are ill, otherwise they would not be in hospital! These co-pathologies, whether they are the ones which brought the patient into hospital or not, may make the patients more susceptible to tissue damage, and acknowledgement must be given to these. It is worthwhile for nurses to know what effects the patients disease process has on the patient and correlate these with their risk of developing pressure ulcers as a result. I find that in many instances that these are not taken into consideration. Also, think about pre-admission care. If a person is to be hospitalised for surgery, they generally know in advance of the admission date and many undergo a pre-op assessment clinic. Why can't info be disseminated to them of the risk of tissue breakdown due to surgery. Giving them this type of advice may help them 'build' themselves up a little, to help them tolerate the malnutrition experienced due to pre and post op fasting and catabolic states? You are right, much more should be and can be done. It is worth the while for trusts to look into these ideas. Research has shown, that across the NHS hospitals, that pressure ulcers can cost up to £30M per annum, and that is not counting litigation costs!
Good luck with your research.