Beyond Knowledge and Attitudes: Translating Pressure Injury Prevention Education Into Reliable Bedside Nursing Practice

Dear Editor,

1.

We read with great interest the systematic review by Saleh et al., entitled ‘Nurses' Knowledge and Attitudes Toward Pressure Injury Prevention: A Systematic Review’ [1]. This timely review synthesises global evidence on nurses' knowledge, attitudes and practices related to pressure ulcers/injuries prevention and highlights a persistent concern in clinical nursing: although nurses generally recognise the importance of prevention, knowledge deficits and inconsistent translation into practice remain common [1]. Previous systematic reviews and meta‐analyses have similarly shown that nurses' knowledge of pressure injury prevention remains variable across clinical settings, assessment tools and countries [2, 3]. This finding deserves further discussion from the perspective of bedside implementation and nursing quality governance.

First, inadequate knowledge should not be interpreted merely as an individual nurse's educational deficiency. Pressure injury prevention is highly context dependent. The knowledge required in an intensive care unit, operating room, orthopaedic ward, outpatient wound clinic or long‐term care setting may differ substantially. Evidence based on commonly used instruments, such as the Pressure Ulcer Knowledge Assessment Tool and the Attitude towards Pressure Ulcer Prevention instrument, suggests that knowledge and attitudes may vary among nurses and nursing students, indicating the need for targeted rather than uniform education [4]. Therefore, future education should move beyond general lectures and adopt role‐specific competency frameworks. For example, operating room nurses may require more training on positioning, device‐related pressure injury and intraoperative padding, whereas orthopaedic and neurosurgical nurses may need greater emphasis on immobility, sensory impairment, nutritional risk and postoperative skin surveillance.

Second, positive attitudes do not automatically lead to reliable preventive behaviour. The knowledge–attitude–practice gap may be shaped by workload, staffing levels, equipment availability, documentation burden and unclear accountability. A recent systematic review and meta‐analysis on nurses' knowledge, attitudes and practices further supports the view that improving awareness alone may be insufficient without changes in clinical workflow and implementation conditions [5]. Therefore, education should be linked with standardised bedside workflows. A practical prevention bundle may include early risk assessment, scheduled skin inspection, repositioning plans, moisture and incontinence management, nutrition screening, medical device skin checks and escalation criteria for high‐risk patients. Each step should have a clearly assigned responsible person and be embedded into routine nursing documentation.

Third, pressure injury prevention education should be competency based rather than attendance based. Completion of a training session does not necessarily indicate that nurses can correctly assess risk, stage pressure injuries, select preventive surfaces or implement repositioning strategies. Hospitals should consider combining online learning, case‐based discussion, bedside demonstration and periodic competency assessment. Simulation‐based training using common high‐risk scenarios, such as sacral pressure injury in immobilised patients or nasal pressure injury from oxygen devices, may help nurses convert theoretical knowledge into clinical decision‐making.

Fourth, prevention should be incorporated into measurable nursing‐sensitive quality indicators. Regular audits could monitor the timeliness of risk assessment, completeness of skin inspection, compliance with repositioning, device‐related pressure injury checks, use of pressure‐redistributing surfaces and nutrition referral for high‐risk patients. These process indicators should then be linked with outcome indicators, including hospital‐acquired pressure injury incidence, severity, anatomical location and avoidability. Such feedback can transform education from a one‐time intervention into a continuous quality‐improvement cycle.

Finally, the review by Saleh et al. also suggests that future studies should pay greater attention to implementation outcomes [1]. In addition to measuring knowledge and attitudes, researchers should evaluate whether educational interventions improve actual bedside behaviour and reduce hospital‐acquired pressure injuries. Multicentre pragmatic studies comparing conventional education, competency‐based training and education plus audit‐feedback models may provide more actionable evidence for nursing managers.

In conclusion, Saleh et al. have provided an important synthesis of nurses' knowledge and attitudes towards pressure injury prevention [1]. The next challenge is not only to increase awareness, but also to build a reliable system that converts knowledge into consistent bedside action. Role‐specific training, standardised workflows, competency assessment and nursing‐sensitive quality indicators may be key steps toward safer and more effective pressure injury prevention.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.