Objective To explore the barriers to the implementation of prone position ventilation (PPV) in burn patients, and to construct a theoretical model, so as to provide references for improving adherence and safety of this technique. Methods A purposive sampling method was used to recruit 31 stakeholders involved in PPV in the burn unit, including 15 nurses, 7 physicians, 3 managers, and 6 patients. Semi- structured interviews were conducted among them, and the NVivo 14.0 software was utilized to analyze the interview data following the procedural grounded theory approach, the open, axial, and selective coding were carried out sequentially to extract concepts and categories and to develop a theoretical model. Results A total of 365 codes and 33 initial concepts were generated, which were finally grouped into 10 categories: heavy physical burden, insufficient cognition, psychological distress, safety-related operational barriers, clinical decision- making deviation, insufficient medical and nursing manpower support, shortage of PPV-specific tools, environmental constraints, inadequate monitoring and evaluation, and uncoordinated organizational processes, which were further integrated into five core domains (person, task, tool, organization, and environment). Conclusion Multiple interrelated barriers exist in the implementation of PPV among burn patients, originating from five system dimensions: person, task, tool, organization, and environment. Improvements should follow a systems-integration approach, promoting coordinated advancement in patient management, staff training, tool optimization, environmental support, and institutional development to enhance the overall safety and standardization of PPV practice.