Intensive care nurses’ knowledge of pressure injury prevention

doi:10.21203/rs.3.rs-4889364/v1

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Research Article

Intensive care nurses’ knowledge of pressure injury prevention

https://doi.org/10.21203/rs.3.rs-4889364/v1

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Background

Pressure injuries (PI) continue to be a major public health concern due to their high prevalence in critically ill patients admitted in the intensive care units (ICUs). The prevalence continues to increase despite the scientific and technological advancements in pressure injury prevention. Poor knowledge and lack of using evidence-based practice by nurses have a significant contribution to the higher prevalence of pressure injuries le ading to prolonged hospital stays and poor patient outcomes. The purpose of this study was to describe the intensive care nurses’ knowledge of PI prevention.

Methods

A descriptive cross-sectional design was used collect the data from 101 nurses working in four ICUs of an academic hospital in Gauteng Province, South Africa. The revised version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0) was used to collect data from a convenience sample of intensive care nurses. Descriptive and inferential statistics were used to analyse data. Statistical tests included the Shapiro Wilk test, univariate and multivariate linear regression and Cronbach alpha coefficient tests. A p-value of less than 0.05 was deemed statistically significant.

Results

The mean knowledge of nurses (N = 101) was 42.16% (SD 12.09). This score indicates poor knowledge of pressure injury prevention. The lowest scores were found in prevention of pressure injuries” (25%) and “classification and observation” (39.5%), respectively. The higher level of education (14.00; 95% CI 2.90-25.11; p = 0.014), seniority (15.58; 95% CI 2.92–28.24; p = 0.016) position, and years of experience (6.38; 95% CI 9.70–5.45; p = 0.039), were statistically significant to predict appropriate prevention and management of pressure injuries.

Conclusion

The study findings revealed that intensive care nurses lack knowledge of prevention measures, classification, and observation of stages. This may indicate that they may not be able to use risk assessment tools effectively in clinical practice. Improving training and providing intensive care nurses with adequate information about evidence-based practices to prevent PI could strengthen their contribution to patient safety.

Pressure injury

prevention

knowledge

intensive care unit

Pressure injuries (PIs) continue to be a major public health concern due to their high prevalence in critically ill patients admitted in the intensive care units (ICUs). There has been an increase in the prevalence of pressure injuries internationally despite the current scientific and technological advancements in pressure injury prevention. The international incidence rates for patients with pressure injuries range from 8–40% for acute care settings^{1, 2}. A meta-analysis on the global prevalence of PI suggested 12.8%, with a hospital-acquired pressure injury (HAPI) incidence of 8.4% ³. This makes pressure injuries a major difficult-to-treat health problem, which is often expensive and complex.

Critically ill patients are more likely to develop pressure injuries than patients in general wards ⁴. Furthermore, ICU patients are 3.8 times more likely to develop a PI than non-intensive care patients⁵. Severe illness, comorbidities, restricted movement and bed rest complications predisposes ICU patients to a higher risk of developing PI ⁶.

Although the National Pressure Ulcer Advisory Panel National (NPUAP) provided many protocols, guidelines, and educational materials related to pressure injury prevention to all organizations, pressure injuries remain a problem in the hospital setting ⁷. Guidelines were developed to help ensure consistent, evidence-based care of patients using the most up-to-date and relevant knowledge available, however, these guidelines have not been implemented in most ICUs around the world ^{8, 9, 10}. According to international literature, it has been identified that nurses’ knowledge of PIP is poor ^{11, 12, 13}

The findings of a Sweden study on nurses' knowledge and practice of existing guidelines on prevention of pressure ulcers found that the majority of nurses had inadequate knowledge and practice to implement guidelines ¹⁴. Similarly, a study in Belgium found that the knowledge of nurses about the prevention of pressure injuries was inadequate ¹⁵. Additionally, the results of a South African study revealed that the knowledge and practices of nurses on pressure injury prevention were unsatisfactory¹⁶.. The findings of a systematic review on the nurse’s knowledge of pressure injury prevention indicated that the nurses have poor knowledge of PIP irrespective of their geographic location ¹⁷.

Hospital-acquired pressure injuries remain a significant complication of hospitalisation, despite increased awareness and knowledge ¹⁸. Common barriers to implementing pressure injury prevention guidelines are knowledge deficit and a negative attitude towards preventing pressure injuries ¹⁹. Other barriers identified in a systematic review on barriers and facilitators on PIP included poor staffing, time constraints, shortage of resources, and un-cooperative patients ²⁰.

Knowledge of pressure injuries, including risk, prevention, staging, and treatment, is essential in preventing pressure injuries and their associated complications ²¹. Nurses require updated knowledge to determine which patients need prevention, which preventative methods are most effective, and how best to apply these methods of prevention ¹⁹. Identifying gaps in knowledge and evaluating nurses' attitudes and practices about the importance of preventing and managing pressure injuries is vital ²².

Aim

This study aimed to describe intensive care nurses’ knowledge of pressure injury prevention.

Design

A descriptive cross-sectional design was used in this study ²³.

Study Setting

Data were collected from September to December 2020 in four ICUs of an academic hospital in Gauteng province, South Africa. These ICUs included multidisciplinary, trauma, neurosurgical and cardiothoracic ICU. The severity of illness and length of stay of the critically ill patients are similar in these four units. On average, six to seven patients in the multidisciplinary and neurosurgical ICUs develop pressure injuries every month compared to two to four patients in the trauma and cardiothoracic ICUs. The Waterlow scale is the risk assessment tool used at the study setting.

Population, sample and sampling

The accessible population comprised all registered nurses working in ICU at the study setting. At the time of the study, there were approximately 135 nurses practising in these units. We included registered nurses who provided direct care for adult patients and have worked for a minimum of six months in these ICUs. A convenience sample of 101 was calculated by using Raosoft sample size calculator ²⁴, after setting the indicator percentage at 0.50, the margin of error at 5%, and the confidence interval at 95%.

Instrument

A modified version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) version 2.0 was used to achieve the study objectives. The PUKAT version 2.0 is a self-administered questionnaire developed initially in 2010 ¹⁵ and revised in 2017 ¹⁹.

The questionnaire consists of two sections. The first section contained six questions assessing the demographic data: gender, age, the highest level of education, ICU experience, current position and type of ICU. The second section consists of 25 multiple choice questions divided into six themes. The themes include "aetiology", "classification and observation", "risk assessment", "nutrition", "prevention of pressure ulcers" and "specific patient groups". The correct answer was scored one while the wrong answer and "I do not know" answers were scored zero, with a possible range between 0 and 25. A score of 15/25 (60%) indicates adequate knowledge of pressure injury prevention ²⁵.

The questionnaire was subjected to face and content validity by five experts who had more than ten years of experience in the field (3) and were critical care lecturers (2) and members of the Critical Care Society of South Africa (CCSSA). The wording of three items was modified based on feedback from the expert panel. No items were added or removed. A pilot test was conducted on 5 participants challenges were encountered and no changes needed to be made. The results of the pilot test were included in the main study.

Ethical considerations

Ethical clearance and permission to conduct the study were obtained from the university’s Human research committee (M200364), as well as the hospital management where the study was conducted. Participants’ privacy was reserved by ensuring that they have the right whether to participate in this study or not and to withdraw at any time. No form of personal identification was incorporated into the study; therefore, confidentiality and anonymity of the respondents were guaranteed.

Data collection

Data collection commenced after receiving ethical clearance and permissions from the study settings. The researcher visited the four ICUs, and nurses with characteristics incorporated in the inclusion criteria were chosen. Permission to give a brief presentation about the study at the beginning of each shift was obtained from the operational managers. The potential participants were assured that the study is voluntary, and they must not feel obligated to participate. The nurses, once verbally consented, were given the survey. The researcher remained in the vicinity while the survey was being completed to assist in any questions from the participants.

Data collection commenced from September to December 2020. The ICUs were visited two to three times a week. The questionnaires were handed out in the mornings and collected from the participants in the late afternoons for day shifts, and for night shifts, the surveys were handed out in the early evening and were collected the following day.

However, more time was given to those who needed it. Once the surveys were collected, the researcher coded the questionnaires to maintain anonymity. The questionnaires were then put in a sealed box and kept -under lock and key.

Data analysis

Data was analysed using descriptive and inferential statistical using the Shapiro Wilk test, univariate and multivariate linear regression and Cronbach alpha coefficient tests. Percentages: categorical variables were described as frequencies and percentages; continuous variables, such as years of experience, were assessed for normality using the Shapiro Wilk test.

Normally distributed continuous variables were described as means and standard deviations (SD), and skewed variables were described as medians and interquartile ranges (IQR). A total score on knowledge of pressure injury prevention was calculated by adding the number of correct responses of the 25 questions asked and calculating a percentage. For each of the themes in the questionnaire, a Cronbach alpha coefficient was calculated to measure the internal consistency of each of the items that make up each theme. For each of the scores in each theme, a Shapiro Wilk test was used to determine the distribution of the scores. A Shapiro Wilk p-value of above 0.05 indicated that the scores were normally distributed; hence, the score's distribution was presented as a mean and standard deviation. A Shapiro Wilk p-value of less than 0.05 indicated that the scores were skewed; hence, the score's distribution was presented as a median and interquartile range.

A linear regression model was fitted to determine how each demographic factor predicted knowledge of pressure injury prevention and management independently. Multiple linear regression was then fitted to determine how the demographic factors (adjusted for each other) predicted pressure injury prevention and management knowledge. STATISTICA™ version 13.2 was the statistical software used to analyse the data.

Demographic characteristics

In total, 101 surveys were distributed, and the response rate was 100%. Most of the participants (26.73%, n = 27) were between the ages of 30 and 39 years and the majority were female (89.1%, n = 90). Just over half (51.49%, n = 52) held postgraduate qualifications and 31.68% (n = 32) had 6 to 10 years of ICU experience. Trauma ICU had majority of the respondents (35.64%, n = 36). Table 1 summarizes these results.

Table 1

Demographic characteristics of the respondents (N = 101)
Variable	Frequency	Percentage
Gender Male Female	11 90	10.89% 89.11%
Age 20 to 29yrs 30 to 39yrs 40 to 49yrs 50 to 59yrs 60 to 65yrs	15 27 26 26 7	14.85% 26.73% 25.74% 25.74% 6.93%
Highest level of education Undergraduate diploma/degree Postgraduate diploma/degree Master’s degree	45 52 4	44.55% 51.49% 3.96%
Intensive care experience 6 months to 1 year 2 to 5 years 6 to 10 years 11 to 15 years 16 to 20 years >20 years	17 24 32 12 9 7	16.83% 23.76% 31.68% 11.88% 8.91% 6.93%
Current position Professional nurse Trauma trained/experienced ICU trained/experienced Unit manager	36 10 52 3	35.64% 9.90% 51.49% 2.97%
Type of ICU Trauma Neurosurgery Cardio-thoracic Multidisciplinary	36 14 17 34	35.64% 13.86% 16.83% 33.66%

Knowledge of Pressure Injury Prevention and Management

Knowledge of intensive care nurses was measured using the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0). Table 2 presents the percentage of correct answers on the PUKAT 2.0 for the total group, and for each theme. The mean knowledge score for the sample was 42.16% (SD 12.09). Only six (5.9%) out of 101 respondents achieved 60% or more. No respondent answered all questions correctly. The theme “Prevention of pressure injuries” had the lowest percentage of correct answers (25%) followed by “Classification and observation” (39.5%), respectively. Risk assessment” and “Nutrition” were the themes in which respondents had the highest scores, 100% and 50% respectively.

Table 2

Intensive care Nurses' knowledge of Pressure Injury Prevention
Variable	Mean (SD)	Median (IQR)	Percentage
Total score (%)	12.06		42.16%
Themes
Aetiology and development (items = 6)	2.81(1.25)		46.8%
Classification and observation (items = 4)	1.58 (1.06)		39.5%
Risk assessment (items = 2)		2 (1–2)	100%
Nutrition (items = 3)	1.51 (0.84)		50%
Preventative measures to reduce the amount of pressure (items = 8)		2 (11 − 3)	25%
Specific patient groups (items = 8)	0.96 (0.56)		48%
	n		%
Equal to or more than 60%	6		5.94
Equal to or lower than 59%	95		94.06

Factors associated with knowledge of prevention and prevention of pressure injuries

By analysing the relationship between the intensive care nurses' demographic characteristics and knowledge, it was observed that the mean scores were likely to be influenced by postgraduate education and training and years of experience. The intensive care nurses with an undergraduate degree or diploma were less likely to score higher on the PUKAT questionnaire (-5.41, 95% CI -10.08-0.74; p 0.024) in comparison to nurses with a post basic qualification.

The intensive care nurses with 2–5 years of experience were more likely to score high on the PUKAT questionnaire (6.38, 95% CI 9.70–5.45; p = 0.039) in comparison to nurses with 6–10 years of experience.

The adjusted multiple linear regression models show intensive care nurses aged 20–29 years were more likely to score higher in the PUKAT questionnaire (9.69, 95% CI 2.61–16.77) than nurses aged 30–39 years. This could be linked to the short period between graduation and starting to work as a nurse. Intensive care nurses with a Master's degree scored higher on the PUKAT questionnaire (14.00, 95% CI 2.90-25.11; p = 0.014) than nurses with a postgraduate qualification.

The adjusted multiple linear regression models further revealed that male nurses were more likely to score higher in the PUKAT questionnaire (8.52, 95% CI 1.80-15.26; p = 0.014) in comparison to female intensive care nurses. Unit managers were more likely to score higher on the PUKAT questionnaire (15.58, 95% CI 2.92–28.24; p = 0.016) in comparison to intensive care with an additional qualification in Critical Care or experienced nurses. These results are summarised in Table 3.

Table 3

Association between nurses’ demographics and knowledge of pressure injury prevention
	Unadjusted Odds Ratio		Adjusted Odds Ratio
	OR (95% CI)	p-value	OR (95% CI)	p-value
Gender Male Female	7.39 (-0.16- 14.95) 1	0.014* 1	1.55 (1.22–1.97) 1	0.014* 1
Age 20–29	5.90 (-1.84- 13.63)	0.133	9.69 (2.61–16.77)	0.008*
30–39	1	1		1
30–39	1	1	1	1
40–49	-1.34 (-7.94-5.25)	0.687	-1.42 (7.27–4.43)	0.630
50–59	2.04 (-4.56-8.64)	0.541	3.02 (-4.20–10.24)	0.407
60–65	0.68 (-9.51- 10.86)	0.895	3.58 (-7.14–14.32)	0.508
Education Undergraduate diploma/degree	-5.4(-10.08-0.74)	0.024*	-2.40 (-8.03- 3.24)	0.400
Postgraduate diploma/degree	1	1	1	1
Master’s degree	11.92 (0.02–23.83)	0.050	14.00 (2.90-25.11)	0.014*
Experience 6 months-1 year	-9.18(-15.90-2.47)	0.008*	-10.71(-18.53- -2.89)	0.008*
2–5 years	6.38 (0.33–12.41)	0.039*	2.89 (-3.41–9.18)	0.365
6–10 years	1	1	1	1
11–15 years	-2.13 (-9.70-5.45)	0.579	-1.85 (-9.25-5.54)	0.620
16–20 years	2.76 (-5.68-11.21)	0.517	-0.79 (-9.64-8.06)	0.860
≥20 years	0.73 (-8.61-10.07)	0.877	-0.97 (-10.65-8.71)	0.843
Position Professional Nurse	-7.44 (-12.25- -2.64)	0.003*	-1.44 (-8.03-5.15)	0.665
Unit manager	16 (2.84–29.16)	0.018*	15.58 (2.92–28.24)	0.016*

Cronbach alpha coefficients

The Cronbach alpha coefficients show that there was very poor (Cronbach alpha coefficient

< 0.50) consistency in any of the themes in the PUKAT 2.0 questionnaire responses by the respondents ²⁶. Table 4 summarizes this information.

Table 4

Internal consistency of the items in the PUKAT
Themes	Cronbach alpha coefficient
Theme One: Etiology and development	0.26
Theme Two: Classification and observation	0.31
Theme Three: Risk assessment	0.24
Theme Four: Nutrition	0.11
Theme Five: Preventative measures to reduce the amount of pressure	0.27
Theme Six: Specific patient groups	0.14

This study intended to assess the intensive care nurses’ knowledge of pressure injury prevention. Data was collected using the Knowledge Assessment Tool (PUKAT 2.0) on a sample of 101 (n = 101) nurses working in four adult ICUs at a public hospital in Gauteng Province, South Africa.

The PUKAT 2.0 questionnaire is the most up-to-date knowledge assessment tool on pressure injury prevention ^{27, 28}. All items of the tool were formulated according to the most recent evidence-based guidelines ¹⁵. Also, cases and pictures were added to evaluate theoretical knowledge and practical knowledge ¹⁹.

Several studies conducted in different countries over the past two decades have revealed that the nurse’s knowledge of pressure injury prevention is poor ^{11, 14, 15, 29, 30, 31, 28, 16, 13}. In this study, the overall mean total score for ICU nurses’ knowledge of pressure injury prevention was 42.16% (SD 12.09). A score of 15 or higher, which equates to 60% or higher, indicates an adequate level of knowledge of pressure injury prevention ¹⁸. While these scores are higher than 38.2% and 28.9%, respectively reported from studies using the PUKAT in Turkey ²⁸ and Belgium ²⁹, they are still unsatisfactory. One study conducted in Belgium ¹⁵ reported a knowledge score of 49.3% for registered nurses. Several other studies conducted in different countries like Italy (51.1%) ³¹, Jordan (54.9%) ³², Belgium (50.7%)⁹, Sweden (59.3%) ²⁷ reported low mean total knowledge scores.

Only six (5.9%) out of 101 (n = 101) respondents achieved equal to or more than 60% (cut-off score), and none of the items were answered correctly by all the respondents in this study. The Turkish study ³³ conducted on 150 nurses, determined a knowledge score of 58% while the Korean study ³⁴ conducted on 282 nurses had a 60.1% score. The total overall score in the current study is less than the scores reported in the two Belgian studies by Manderlier et al.¹⁹ and De Meyer et al. ⁹ as well as a Jordanian study by Batiha ³² where the respondents obtained scores of 52%, 50.7% and 54.9%, respectively.

In a recent systematic review and meta-analysis conducted with 4766 nurses, nursing students and assistant nurses, Dalvand et al. ¹⁷ determined the mean score for the level of knowledge on the prevention of pressure injuries was 53.1% and emphasised the cut-off point of the scales used to be lower than 59%.

In our study, the lowest scores were found in the following themes: "classification and observation" with scores of 39.5% and "prevention of pressure injuries" with scores of 25%. The highest scores were found in "risk assessment" (100.0%) and "nutrition" (50.0%). These findings are similar to those of a Belgian ⁹ and Jordanian study ³².

By analysing the relationship between the nurses' characteristics and knowledge, it was observed that the mean scores were likely to be influenced by post basic education and training and years of experience. The intensive care nurses with an undergraduate qualification were less likely to score higher on the PUKAT questionnaire (-5.41, 95% CI -10.08-0.74; p 0.024) in comparison to those with a post basic qualification. The Spanish study ³⁵ analysed the influence of professional experience on nurses’ knowledge and found statistically significant differences between professional nurses with 2–5 and 5–10 years of experience compared to less experienced nurses, the latter having lower knowledge scores. This can be associated with an imbalance between practical and theoretical knowledge.

Intensive care nurses with 2–5 years of experience were more likely to score high on the PUKAT questionnaire (6.38, 95% CI 9.70–5.45; p = 0.039) in comparison to those with 6–10 years of experience. The findings of a systematic review on reported that the current evidence concerning clinical experience on nurses' knowledge about pressure injuries is unclear ³⁶.

The adjusted multiple linear regression models show intensive care nurses aged 20–29 years were more likely to score higher in the PUKAT questionnaire (9.69, 95% CI 2.61–16.77) those aged 30–39 years. Significant higher mean scores for younger age group participants was also found in the Saudi Arabian study ³⁷. This may be explained by the short period between graduation and starting to practice as a nurse.

Intensive care nurses with a master's degree were more likely to score higher on the PUKAT questionnaire (14.00, 95% CI 2.90-25.11; p = 0.014) than those with a postgraduate degree or diploma. The Belgian ¹⁵, Italian ³¹ and Spanish study ³⁵ found a similar correlation between educational background and knowledge.

Limitations

The researchers acknowledge the following limitations:

The study was only conducted in one hospital, in one city and therefore the findings cannot be generalised to other populations.
A relatively small sample size was utilised (n = 101).
A quantitative design was used. This limits the participants’ responses.

Therefore, the study’s findings can only be generalised if it is replicated on a larger scale, involving more ICUs, in other hospitals.

In conclusion, this study assessed the intensive care nurse’s knowledge of pressure injury prevention. The findings brought to light gaps in pressure injury prevention and theoretical knowledge and practice knowledge. It also highlighted the need for intensive care nurses to acquire evidence-based knowledge related to clinical practice. Nurses play a pivotal role in preventing pressure injuries, risk identification, classification and management of pressure injuries. The results showed that nurses who participated in this study had poor knowledge of pressure injury prevention and therefore not likely to protect patients under their care adequately. The findings of our study have significant implications for nurse education and training programmes, potentially informing policy changes to enhance patient care in ICU settings.

CCSSA

Critical Care Society of South Africa

ICU

Intensive care unit

NPUAP

National Pressure Ulcer Advisory Panel

Pressure injuries

PIP

Pressure injury Prevention

PUKAT

Pressure Ulcer Knowledge Assessment Tool.

Acknowledgements

We extend our gratitude to all the intensive care nurses who participated in this study. We would also like to thank the hospital managers at the study setting.

Authors’ contributions

RS: Conceptualization, Methodology, Data collection, Data analysis and interpretation. Manuscript original draft preparation and editing. NK: Conceptualization, Supervision, Methodology, Formal Analysis, Writing - Original draft preparation, reviewing and editing. All authors have read and approved the manuscript.

Funding

The researchers did not receive any funding.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on request.

Declaration

Ethics approval and consent to participate: This research was approved by the Human Research Ethics Committee of the University of the Witwatersrand (M200364). Permissions were obtained from the study setting and informed consent forms were received from all participants. The study was performed in accordance with the general ethical principles.

Consent for publication

The article does not contain any individual details, and therefore, consent for publication is not applicable.

Competing interests

The authors declare that they have no competing interests.

de Sousa RC, Faustino AM. Nurses’ understanding about the pressure injury prevention and care/Conhecimento de enfermeiros sobre prevenção e cuidados de lesão por pressão. Revista de Pesquisa Cuidado é Fundamental Online. 2019 Jul 1;11(4):992-7.

Becker D, Tozo TC, Batista SS, Mattos AL, Silva MC, Rigon S, Laynes RL, Salomão EC, Hubner KD, Sorbara SG, Duarte PA. Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. Intensive and Critical Care Nursing. 2017 Oct 1; 42:55-61.

Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. International journal of nursing studies. 2020 May 1; 105:103546.

Nowicki JL, Mullany D, Spooner A, Nowicki TA, Mckay PM, Corley A, Fulbrook P, Fraser JF. Are pressure injuries related to skin failure in critically ill patients?. Australian Critical Care. 2018 Sep 1;31(5):257-63.

Coyer F, Miles S, Gosley S, Fulbrook P, Sketcher-Baker K, Cook JL, Whitmore J. Pressure injury prevalence in intensive care versus non-intensive care patients: a state-wide comparison. Australian Critical Care. 2017 Sep 1;30(5):244-50.

Fulbrook P, Anderson A. Pressure injury risk assessment in intensive care: comparison of inter‐rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales. Journal of advanced nursing. 2016 Mar;72(3):680-92.

Haesler E. National pressure ulcer advisory panel, European pressure ulcer advisory panel and pan pacific pressure injury alliance. Prevention and treatment of pressure ulcers: quick reference guide. 2014:14-32.

Tayyib N, Coyer F, Lewis PA. Implementing a pressure ulcer prevention bundle in an adult intensive care. Intensive and Critical Care Nursing. 2016 Dec 1; 37:27-36.

De Meyer D, Verhaeghe S, Van Hecke A, Beeckman D. Knowledge of nurses and nursing assistants about pressure ulcer prevention: A survey in 16 Belgian hospitals using the PUKAT 2.0 tool. Journal of tissue viability. 2019 May 1;28(2):59-69.

Fulbrook P, Lawrence P, Miles S. Australian nurses' knowledge of pressure injury prevention and management: a cross-sectional survey. Journal of Wound Ostomy & Continence Nursing. 2019 Mar 1;46(2):106-12.

Gunningberg L, Lindholm C, Carlsson M, Sjödén PO. Risk, prevention and treatment of pressure ulcers–nursing staff knowledge and documentation. Scandinavian journal of caring sciences. 2001 Sep 11;15(3):257-63.

Nuru N, Zewdu F, Amsalu S, Mehretie Y. Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC nursing. 2015 Dec; 14:1-8.

Hu L, Sae-Sia W, Kitrungrote L. Intensive care nurses’ knowledge, attitude, and practice of pressure injury prevention in China: A cross-sectional study. Risk Management and Healthcare Policy. 2021 Oct 11:4257-67.
Clark M, Bours GJ, Delfoor T. Summary report on the prevalence of pressure ulcer.
Beeckman D, Vanderwee K, Demarré L, Paquay L, Van Hecke A, Defloor T. Pressure ulcer prevention: development and psychometric validation of a knowledge assessment instrument. International journal of nursing studies. 2010 Apr 1;47(4):399-410.
Malinga S, Dlungwane T. Nurses' Knowledge, Attitudes and Practices regarding Pressure Ulcer Prevention in the Umgungundlovu District, South Africa. Africa Journal of Nursing & Midwifery. 2020 Jul 1;22(2).
Dalvand S, Ebadi A, Gheshlagh RG. Nurses’ knowledge on pressure injury prevention: a systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Clinical, cosmetic and investigational dermatology. 2018 Nov 23:613-20.

Wong AL, Walia GS, Bello R, Aquino CS, Sacks JM. Pressure ulcer prevalence and perceptions on prevention: a hospital-wide survey of health professionals. Journal of Wound Care. 2018 Apr 1;27(Sup4): S29-35.

Manderlier B, Van Damme N, Vanderwee K, Verhaeghe S, Van Hecke A, Beeckman D. Development and psychometric validation of PUKAT 2· 0, a knowledge assessment tool for pressure ulcer prevention. International Wound Journal. 2017 Dec;14(6):1041-51.

Wu Z, Song B, Liu Y, Zhai Y, Chen S, Lin F. Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review. Journal of tissue viability. 2023 Aug 1;32(3):355-64.
Pieper B, Zulkowski K. The Pieper-Zulkowski pressure ulcer knowledge test. Advances in skin & wound care. 2014 Sep 1;27(9):413-20.
Wound O. WOCN 2016 guideline for prevention and management of pressure injuries (ulcers): an executive summary. Journal of Wound Ostomy & Continence Nursing. 2017 May 1;44(3):241-6.
Polit, D.F. and Beck, C.T. (2017) Nursing Research: Generating and Assessing Evidence for Nursing Practice. 10th Edition, Wolters Kluwer Health, Philadelphia.

Polit D, Beck C. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins; 2020 Dec 30.

Raosoft (2004) Raosoft Sample Size Calculator. Raosoft, Inc., Seattle.
http://www.raosoft.com/samplesize.html. Accessed 09 August 2024.

Tirgari B, Mirshekari L, Forouzi MA. Pressure injury prevention: knowledge and attitudes of Iranian intensive care nurses. Advances in skin & wound care. 2018 Apr 1;31(4):1-8.
Tavakol M, Dennick R. Making sense of Cronbach's alpha. International journal of medical education. 2011; 2:53.
Gunningberg L, Mårtensson G, Mamhidir AG, Florin J, Muntlin Athlin Å, Bååth C. Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. International wound journal. 2015 Aug;12(4):462-8.

Kısacık ÖG, Sönmez M. Pressure ulcers prevention: Turkish nursing students' knowledge and attitudes and influencing factors. Journal of Tissue Viability. 2020 Feb 1;29(1):24-31.
Demarré L, Vanderwee K, Defloor T, Verhaeghe S, Schoonhoven L, Beeckman D. Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes. Journal of clinical nursing. 2012 May;21(9‐10):1425-34.
Simonetti V, Comparcini D, Flacco ME, Di Giovanni P, Cicolini G. Nursing students' knowledge and attitude on pressure ulcer prevention evidence-based guidelines: a multicenter cross-sectional study. Nurse education today. 2015 Apr 1;35(4):573-9.

Batiha AM. Critical care nurses’ knowledge, attitudes, and perceived barriers towards pressure injuries prevention. International Journal of Advanced Nursing Studies. 2018;7(2):117.

Tulek Z, Polat C, Ozkan I, Theofanidis D, Togrol RE. Validity and reliability of the Turkish version of the pressure ulcer prevention knowledge assessment instrument. Journal of tissue viability. 2016 Nov 1;25(4):201-8.

Kim E, Choi M, Lee J, Kim YA. Reusability of EMR data for applying Cubbin and Jackson pressure ulcer risk assessment scale in critical care patients. Healthcare Informatics Research. 2013 Dec 31;19(4):261-70.
Pancorbo‐Hidalgo PL, García‐Fernández FP, López‐Medina IM, López‐Ortega J. Pressure ulcer care in Spain: nurses’ knowledge and clinical practice. Journal of Advanced Nursing. 2007 May;58(4):327-38.
Suva G, Sharma T, Campbell KE, Sibbald RG, An D, Woo K. Strategies to support pressure injury best practices by the inter‐professional team: A systematic review. International Wound Journal. 2018 Aug;15(4):580-9.

Kaddourah B, Abu-Shaheen AK, Al-Tannir M. Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study. BMC nursing. 2016 Dec; 15:1-6.

No competing interests reported.

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Intensive care nurses’ knowledge of pressure injury prevention

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Version 1

Abstract

Background

Methods

Results

Conclusion

Background

Aim

Methods

Design

Study Setting

Population, sample and sampling

Instrument

Ethical considerations

Data collection

Data analysis

Results

Demographic characteristics

Knowledge of Pressure Injury Prevention and Management

Factors associated with knowledge of prevention and prevention of pressure injuries

Cronbach alpha coefficients

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1