Nurses' knowledge, attitudes, and behaviors related to pressure injury prevention: A large-scale cross-sectional survey in mainland China.

AIMS To determine the level of and factors in nurses' knowledge, attitudes and behaviors towards pressure injury (PI) prevention. BACKGROUND Although there has been a declining trend in global PI prevalence and hospital-acquired rates in recent years, this has not been the case in China. Evidence in the literature indicates the importance of nurses' knowledge, attitudes, and behaviors for promoting PI-prevention. DESIGN Cross-sectional study. METHODS A total of 1,806 nurses from 10 tertiary general hospitals in Hunan Province, China, participated in this study. Nurses' knowledge and attitudes were assessed using Pieper's Pressure Ulcer Knowledge Test and Attitude towards Pressure Ulcer Prevention Instrument, respectively, and behaviors were measured using a researcher self-designed questionnaire. Multiple logistic regression analysis determined factors affecting the nurses' PI-prevention knowledge, attitudes and behaviors. A STROBE checklist was used to report findings. RESULTS Among all nurses involved in this study, 41.7% had insufficient PI-prevention knowledge, 46.6% had negative PI-prevention attitudes, and 21.8% had poor PI-prevention behavior. Nurses with a bachelor's degree or above were more likely to have adequate PI-prevention knowledge. Increased PI-prevention training frequency increased the nurses' positive attitude scores for PI-prevention; longer years of service and a higher number of PI-prevention trainings attended predicted better PI-prevention behaviors. CONCLUSION Chinese nurses' PI-prevention knowledge and attitudes in this study were unsatisfactory, while their PI-prevention behavior was acceptable. Increasing PI-prevention training frequency can help improve Chinese nurses' PI-prevention attitudes and further behavior. Having a minimum of a bachelor degree may be beneficial to Chinese nurses' PI-prevention knowledge, but more evidence is needed. RELEVANCE TO CLINICAL PRACTICE Chinese nurses have insufficient knowledge about patient repositioning, inadequate practices in patient nutrition assessment, and a lack of confidence in their personal competence. The key solution for the above issues is to promote ongoing education and training based on strong clinical leadership.