Abstract
This study aimed to investigate Korean nurses' level of knowledge, attitude, and performance of pressure ulcer prevention in long‐term care facilities. A descriptive study was performed. Convenience sampling was used, and registered nurses were recruited from the attendees of a continuing education programme for nurses in long‐term care facilities. A total of 282 participants (RN) completed the questionnaire. Data were collected from September to December 2015. Nurses participating in this study demonstrated a moderate level of knowledge of pressure ulcer prevention (60.1%) and exhibited positive attitudes towards pressure ulcer prevention (33.80 ± 2.48). Nurses regularly assessed the risk factors of pressure ulcers during the hospitalisation period for all patients in the hospital when performing pressure ulcer prevention care. However, the plan for preventive nursing care was not properly reviewed. It was also found that nurses did not consider changes in the patient's condition as important to why they had to change their nursing plans to prevent pressure ulcer. Therefore, this study suggested that appropriate guidelines, education programmes, and an environment that makes it possible to provide continuing education should be created for nurses to prevent pressure ulcers in Korea's long‐term care facilities.
Keywords: attitude, knowledge, long‐term care facilities, performance, pressure ulcer prevention
1. INTRODUCTION
As the demand for health care and nursing increases because of the growing aging population, the need for institutions to provide long‐term care for the elderly is also rising.1 Such ever‐growing demand has led long‐term care facilities for seniors to mushroom in Korea exponentially, from 19 in 2000 to 825 in 2010.2 A total of 92.7% of long‐term care facilities users are over 65 years old. Most of them are malnourished and in need of a great deal of care from others.3
In reality, pressure ulcers (PU) are commonly found in these aged patients with restricted mobility.4 A PU is a localised injury of the skin and/or underlying tissue, which occurs because of constant pressure on its area and results in constant physical and psychological affliction for patients and their families.5 As the aged patient population is swelling, PU is widespread among older individuals staying in long‐term care facilities, and as a result, there is a great need for well‐planned, intensive care nursing for them. Accordingly, PU management becomes vital as PUs are accepted as an important safety issue for patients inside and outside of Korea.6 In particular, preventive nursing care is considered vital because PU prevention is mostly achievable through preventive nursing care.7
Specifically, nurses can play the most important role in assessing PU risk factors: when patients are admitted into long‐term care facilities, nurses observe the injury‐prone area in order to identify the preventive early stage and then implement preventive nursing care.8, 9 This care should be performed on the basis of substantial nursing knowledge on PU because tailored nursing care can be provided for PU prevention once a PU is precisely assessed by nurses with extensive knowledge of PUs.10, 11
This study is intended to understand nurses' nursing knowledge, attitude, and PU nursing performance and thus provide them the basic data to develop the guideline and education programmes applicable to long‐term care facilities of Korea.
2. METHOD
2.1. Design
A descriptive study was performed.
2.2. Sample
Convenience sampling was adopted. Registered nurses were recruited from those who were attending the continuing education programme for nurses of long‐term care facilities. An inclusion criterion for sampling required that registered nurses need to have at least 1‐year clinical experience in ward but not in the outpatient department. A total of 312 nurses responded to questionnaire; 30 of them were excluded because they did not state the demographic data in the questionnaire, and 282 (90%) of them were finally chosen as the sample.
2.3. Instrument
2.3.1. Attitude towards PU prevention
This was measured using the Korean version of the tool modified from Lee11 and developed by Beeckman et al.12 This tool comprises personal competency towards PU prevention (two items), prioritisation of PU (two items), environmental influence (three items), responsibility (two items), and confidence in effectiveness of prevention (two items).
Items gained scores of 1 for “Strongly disagree” to 4 for “Strongly agree,” with items 4, 5, 8, and 11 reversely scored. The possible score ranged from 44 to 11. Higher scores reflect the more positive attitudes. Cronbach alpha of the original tool was 0.79,12 and Cronbach alpha of the Korean version11 was 0.71. In this study, Cronbach alpha was 0.72.
2.3.2. Knowledge of PU prevention management
This was measured using the Korean version tool modified from Lee11 and developed by Beeckman, et al.13 The instrument includes 19 multiple choice questions with three answer options and reflects six domains expressing the most relevant aspects of PU prevention: This tool consists of pathogenesis of PU (six items), PU classification system and observation (three items), assessment in risk of PU (one item), nutrition (one item), preventive strategy for diminishing pressure and shear (four items), and preventive strategy for diminishing time of exposure to pressure and shear (four items). Correct answer percentage indicated the construct of a 19‐item instrument in six factor items. Score boundary is 0 to 19 points, and a higher score means a higher knowledge of PU prevention. When it was developed, Cronbach alpha was 0.77. Cronbach alpha of the Korean version was 0.73. In this study, Cronbach alpha was 0.77.
2.3.3. Performance of nursing care for PU prevention
This was measured using the Korean version of the tool modified from Seo14 and developed by Moore and Price.10 This tool is made up of eight items: 1) target patients for assessing risk of PU, 2) when to first assess PU risk, 3) target patients for recording the PU prevention plan, 4) time for checking the PU prevention plan, 5) reasons for checking the PU prevention plan, 6) time for changing the PU prevention plan, 7) whether or not nursing was performed to prevent PU, and 8) reasons for nursing to prevent PU. In this study, Cronbach alpha was 0.68.
2.4. Data collection and analysis
Data were collected from September to December 2015. Questionnaires and cover letters with information on the study were distributed to nurses. Participants were requested to complete the questionnaire individually. Time given to complete the questionnaire was estimated at 25 to 30 minutes. Participants submitted their questionnaires to the researcher's assistants. All questionnaires were reviewed and evaluated for possible missing answers. Analyses were performed using IBM SPSS 18.0 (SPSS Inc., Chicago, Illinois). Descriptive statistics (means, SD, frequencies, and percentages) was used for all questionnaire items.
2.5. Ethical considerations
This study was granted approval by the institutional review board of Severance Hospital (IRB Approval Number: 2011‐1029). The purpose and procedure of the study, the voluntary nature of participation, and the assured confidentiality were explained to participants in detail. Consent was obtained on the return of the completed questionnaires, and participation was absolutely voluntary.
3. RESULTS
3.1. Demographic characteristics of participants
Most of the participants were women, and their mean age was 40.29 years. The majority of the participants held a bachelor degree (45.0) and an associated degree (49.6). The total average clinical experience length was 54.30 months. The clinical work length in long‐term care facilities was 46.94 months, and 57.1% of participants were staff nurses. When asked whether they had received PU‐related education, 222 (78%) of the respondents answered they had received education, and the method of education was through continued education (78.0) (Table 1).
Table 1.
Demographic characteristics of participants (N = 282)
| Variables | Characteristics | N (%) or M ± SD |
|---|---|---|
| Gender | Male | 12 (4.3) |
| Female | 270 (95.7) | |
| Age | 40.29 ± 8.46 | |
| Educational degree | Associate degree | 140 (49.6) |
| Bachelor degree | 127 (45.0) | |
| MScN degree | 14 (5.0) | |
| PhD degree | 1 (0.4) | |
| Total clinical experience (month) | 54.30 ± 87.00 | |
| Clinical experience at LTCF (month) | 46.94 ± 55.04 | |
| Position* | Staff nurse | 161 (57.1) |
| Senior nurse(charge nurse) | 31 (11.0) | |
| Head nurse | 90 (31.9) | |
| PU‐related education programmes | Yes | 222 (78.0) |
| No | 60 (21.3) | |
| Type of PU‐related education programme | Continue education | 220 (78.0) |
| Professional education programme | 8 (2.8) | |
| Education in their hospitals | 34 (12.1) | |
| Academic conference, symposium | 20 (7.1) |
Abbreviations: LTCF, long‐term care facility; PU, pressure ulcer.
3.2. Attitude towards PU prevention
The results presented show that participants exhibited positive attitudes towards PU prevention with a mean score of 33.80 ± 2.48. Items such as “Sense of responsibility for PU Prevention” showed the highest score with 3.34 ± 65. Then came “Confidence in the Effectiveness of Prevention” with 3.20 ± 0.43 followed by the “Impact of PU” with 3.19 ± 0.51. Finally, the score for “Prioritisation of PU Prevention” was 2.94 ± 0.52. In “Personal Competency to Prevent PU”, however, participants scored the lowest points (2.60 ± 0.50). These results showed a high degree of responsibility for preventing PU, but they showed a very low level of confidence in preventing PU. Among the detailed items, “PU causes discomfort for patient” scored 3.59 ± 0.76; “PU prevention is important” scored 3.54 ± 0.77; and “I feel it my important duty to prevent PU” scored 3.42 ± 0.61. The response to the question of having to pay much attention to prevent a PU recorded the lowest score, 2.37 ± 0.68. When asked if they were adequately trained to prevent PU, the respondents scored 2.60 ± 0.60. Nurses think it is important to prevent PU, but they were able to confirm that they lacked interest and were not properly trained (Table 2).
Table 2.
Attitude towards PU prevention (N = 282)
| Variables | Score |
|---|---|
| Personal competency to prevent PU (two items) | 2.64 ± 0.50 |
| 1) I feel confident in being able to prevent PUa | 2.68 ± 0.54 |
| 2) I was adequately trained to prevent PUa | 2.60 ± 0.60 |
| Prioritisation of PU prevention (two items) | 2.94 ± 0.52 |
| 3) Heavy attention is paid to PU preventiona | 2.37 ± 0.68 |
| 4) PU prevention is not that importantb | 3.54 ± 0.77 |
| Impact of PU (three items) | 3.19 ± 0.51 |
| 5) PU almost never causes discomfort for patientb | 3.59 ± 0.76 |
| 6) Patient's financial burden due to PU is very higha | 3.01 ± 0.72 |
| 7) PU's financial impact on society is higha | 3.00 ± 0.71 |
| Responsibility in PU prevention (two items) | 3.34 ± 0.65 |
| 8) I am not responsible even if PU develops in my patientsb | 3.25 ± 0.57 |
| 9) I feel it my duty to prevent PUa | 3.42 ± 0.61 |
| Confidence in effectiveness of prevention (two items) | 3.20 ± 0.43 |
| 10) PU is preventable in high‐risk patientsa | 3.13 ± 0.52 |
| 11) PU prevention is almost impossibleb | 3.26 ± 0.51 |
| Total of each item | 3.05 ± 0.30 |
| Total of all items | 33.80 ± 2.48 |
Abbreviation: PU: Pressure ulcer.
Positively worded item.
Negatively worded item.
3.3. Knowledge on nursing care for PU prevention
A total of 282 respondents answered all items given in the tool for knowledge. Their correct answer rate was 60.1%. This score means that they have a moderate level of knowledge. In the order of scores in each sub‐item, nutrition ranked the highest at 74.8%, followed by the “Preventive measure to reduce the duration and amount of pressure/shear” at 69.2% and 67.5%, respectively, and the “Etiology and development of PU” at 62.2%. However, assessment regarding the risk of PU (34.8) and classification and observation of PU (37.4) scored the lowest. By item, questions on the use of mattresses to prevent PU obtained the highest score at a 95% correct rate. The correct rate associated with the change in position for patients at risk of PU lying on the supporting surface was 92.2%. The patients who are less likely to have PUs were 91.1%. The answer to the reason for reposition was the lowest (20.6). The question about observing patients with PU risk also scored poorly (24.1). This means respondents demonstrated that the preventive measures for reducing the duration and quantity of pressure/shearing were well known. However, they have insufficient knowledge on the assessment of risk of PU incidence, repositioning, and the frequency of skin inspection (Table 3).
Table 3.
Knowledge on PU prevention care (N = 282)
| Variables | N (%) | M ± SD |
|---|---|---|
| Aetiology and incidence | 1052 (62.2) | 3. 7 3 ± 1 0.48 |
|
1. Which statement is correct? ① Malnutrition causes PU ② Lack of oxygen causes PU ③ Moisture causes PU |
142 (50.4) | 0.50 ± 0.50 |
|
2. Extremely thin patients are more likely to be exposed to risk of PU incidence than obese patients ① Correct—Contact area involved is small and thus amount of pressure is higher ② Incorrect—Pressure is less extensive because thin patients' body weight is lighter than that of obese patients ③ Incorrect—Risk of vascular disorder incidence is higher for obese patients. This increases risk of PU incidence |
205 (72.7) | 0.73 ± 0.45 |
|
3. What happens when patient, sitting in bed in a semi‐upright position (60°), slides down? ① Pressure increases when skin sticks to surface. ② Friction increases when skin sticks to surface ③ Shearing increases when skin sticks to surface |
144 (51.1) | 0.51 ± 0.50 |
|
4. Which statement is correct? ① Soap can dehydrate skin, and it results in higher risk of PU incidence ② Moisture from urine, faces, or wound drainage causes PU ③ Shear is force which occurs when body slides and skin sticks to surface. |
106 (37.6) | 0.38 ± 0.49 |
|
5. Which statement is correct? ① Patient's recent weight loss, below his or her ideal weight, increases risk of PU incidence. ② Very obese patients using medication that decreases peripheral blood circulation are not at risk of PU incidence ③ Poor nutrition and age have no impact on tissue tolerance in case patient has normal weight. |
237 (84.0) | 0.84 ± 0.37 |
|
6. There is NO relationship between PU risk and followings: ① Age ② Dehydration ③ Hypertention |
218 (77.3) | 0.77 ± 0.42 |
| Classification and observation | 316 (37.4) | 1.12 ± 0.85 |
|
7. Which statement is correct? ① Friction and shear may occur when moving patient in bed ② Superficial lesion, preceded by non‐blanchable erythema is probably friction lesion ③ Kissing ulcer (copy lesion) is caused by pressure and shear |
105 (37.2) | 0.37 ± 0.48 |
|
8. In sitting position, PUs are most likely to develop on followings: ① Pelvic area, elbow, and heel ② Knee, ankle, and hip ③ Hip, shoulder, and heel |
143 (50.7) | 0.51 ± 0.50 |
|
9. Which statement is correct? ① All patients at risk of PU incidence should have systematic skin inspection once a week. ② Skin of patients seated in a chair, who cannot move by themselves, should be inspected every 2 to 3 hours. ③ Heels of patients who lie on a pressure‐redistributing surface should be observed daily at minimum. |
68 (24.1) |
0.24 ± 0.43 |
| Risk assessment | 98 (34.8) |
0.35 ± 0.48 |
|
10. Which statement is correct? ① Risk assessment tools identify all patients at high PU risk, who are in need of prevention ② Use of risk assessment scales reduces PU prevention cost ③ Risk assessment scale may not accurately predict risk of PU incidence and therefore should be combined with clinical judgement. |
98 (34.8) |
0.35 ± 0.48 |
| Nutrition | 211 (74.8) | 0.75 ± 0.44 |
|
11. Which statement is correct? ① Malnutrition causes PU. ② Use of nutrition supplements can replace expensive preventive measures. ③ Optimised nutrition can improve patients' general physical condition, and this may contribute to reducing PU incidence Risk. |
211 (74.8) |
0.75 ± 0.44 |
| Preventive measure to reduce the amount of pressure/shear | 761 (67.5) | 2.70 ± 0.93 |
|
12. Sitting position with lowest contact pressure between body and seat is: ① Upright sitting position, with both feet resting on footrest. ② Upright sitting position, with both feet resting on floor. ③ Backwards sitting position, with both legs resting on footrest. |
235 (83.3) |
0.83 ± 0.37 |
|
13. Which repositioning schema reduces PU risk the most? ① Supine position—side 90 lateral position—Supine position—side 90 lateral position—Supine position ② Supine position—side 30 lateral position—Side 30 Lateral position—supine position ③ Supine position—side 30 lateral position—Sitting position—side 30 lateral position—supine |
152 (53.9) | 0.54 ± 0.50 |
|
14. Which statement is correct? ① Patients who are able to change position while sitting should be taught to shift their weight minimum every 60 minutes while sitting on a chair. ② Side lying position, patient should be at 90° angle with bed. ③ Shearing forces affect patient's sacrum maximally when bed head is positioned at 30. |
106 (37.6) | 0.38 ± 0.49 |
|
15. For patients at PU incidence risk, visco‐elastic foam mattress ① Reduces pressure sufficiently and does not need to be combined with repositioning. ② Has to be combined with repositioning every 4 hours. ③ Has to be combined with repositioning every 2 hours. |
268 (95.0) |
0.95 ± 0.22 |
| Preventive measure to reduce duration of pressure/shear | 780 (69.2) | 2.77 ± 0.77 |
|
16. Repositioning is accurate preventive method because ① Magnitude of pressure and shear will be reduced. ② Amount and duration of pressure and shear will be reduced. ③ Duration of pressure and shear will be reduced. |
58 (20.6) | 0.21 ± 0.41 |
|
17. Fewer patients will have PU if: ① Food supplements are provided. ② Areas at risk are massaged. ③ Patients are mobilised. |
257 (91.1) |
0.91 ± 0.29 |
|
18. Which statement is correct? ① Patient at PU risk lying on non‐pressure‐reducing foam mattress should be repositioned every 2 hours. ② Patient at PU risk lying on alternating air mattress should be repositioned every 4 hours. ③ Patient at PU risk lying on foam mattress need not to be repositioned. |
260 (92.2) |
0.92 ± 0.27 |
|
19. When patient is lying on alternating pressure air mattress, prevention of heel PU includes: ① No specific preventive measures. ② Pressure reducing cushion under heels. ③ Cushion under lower legs elevating heels. |
205 (72.7) | 0.73 ± 0.45 |
| Total | 3218 (60.1) | 11.41 ± 2.7 |
Abbreviation: PU, pressure ulcer.
3.4. Performance of nursing care for PU prevention
According to the performance related to PU prevention, to evaluate the risk factor for PUs, the majority of respondents answered “performed all patients” (82.3). In the evaluation period, 205 respondents (72.7) said that they would “continuously evaluate while they are in the hospital.” Most nurses answered that nursing records were completed to prevent PUs for all patients (83.7). For the frequency of checking the PU prevention nursing plan, 104, or 36.9%, of respondents said “I do it on a daily basis”; 74, or 26.2%, of them replied “every week”; and 13, or 4.6%, said “Never.” For reasons of “Why they check the plan?”, 129, or 45.7%, said they do it to “reexamine PU prevention nursing plan”; 100, or 35.5%, replied they observed a change in patient's condition; and 41, or 14.5%, answered they did it because patients developed PUs. This shows that many nurses did not re‐evaluate risk factors when PUs occurred, and very few nurses said they reconfirmed the plan to prevent PUs when the patient's condition changed. From respondents' answers regarding the timing of changing the PU prevention nursing plan, it was found that 126, or 44.3%, of them said they do it “when PU develops during their stay in long‐term care facilities” and 125, or 44.3%, replied “On a daily basis during their stay in long‐term facilities”. More than three quarter (239 or 84.8%) of respondents also said they are carrying out the PU prevention strategy, and 261 or 92.6% said they do it because it is “An important part of nursing practice”. This indicates that respondents are well aware that it is absolutely necessary to perform PU prevention nursing care (Table 4).
Table 4.
Performance of nursing care for PU prevention (N = 282)
| Variables | Characteristics | N (%) |
|---|---|---|
| Target patients for assessing risk of PU | All patients | 232 (82.3) |
| Some of patients | 48 (17.0) | |
| No | 2 (0.7) | |
| When to assess PU riska | When patient is hospitalised | 37 (13.1) |
| While staying in hospital | 205 (72.7) | |
| When PU develops during hospital stay | 37 (13.1) | |
| When I remember it | 0 (0.0) | |
| When I have time | 3 (1.1) | |
| Target patients recording the PU prevention plan | All patients at PU risk | 236 (83.7) |
| Some patients | 44 (15.6) | |
| NO | 2 (0.7) | |
| Time for checking the PU prevention plan | Every day | 104 (36.9) |
| Every week | 74 (26.2) | |
| Rarely | 91 (32.3) | |
| Never | 13 (4.6) | |
| Reasons for checking the PU prevention plana | To reassess the nursing plan | 129 (45.7) |
| Change in the patient's condition | 100 (35.5) | |
| Because PU develops in patient | 41 (14.5) | |
| Never | 12 (4.3) | |
| Time for changing the PU prevention plana | Every day while patient is in hospital | 125 (44.3) |
| When PU develops in patient during hospitalisation | 126 (44.7) | |
| When I remember it | 3 (1.1) | |
| Never | 7 (2.5) | |
| Others | 21 (7.4) | |
| Whether or not preventive nursing care was performed | Yes | 239 (84.8) |
| No | 43 (15.2) | |
| Reasons for nursing to prevent PU | Because it is necessary part of nursing practice | 261 (92.6) |
| Because other nurses do it | 3 (1.1) | |
| Because I want to live up to other nurses' expectations | 2 (0.7) | |
| Because it is hospital policy | 15 (5.3) | |
| Others | 1 (0.4) |
Abbreviation: PU, pressure ulcer.
A plural response.
4. DISCUSSION
Nurses' knowledge, attitudes, and performance in association with practices of PU prevention in long‐term care facilities in Korea have been evaluated. The evaluation result showed that nurses participating in this study held a moderate level of knowledge of PU prevention (60.1%) and exhibited positive attitudes towards PU prevention (33.80 ± 2.48).
The results of this study are similar to many previous studies. For example, Kallman et al15 conducted an attitude test across a health care district in Sweden. They found that nurses had exhibited positive attitudes towards PU prevention. More than 94% of participants indicated that nurses hold important responsibilities for preventing PU. Dilie and Mengistu,16 who examined responses from 217 nurses working in three hospitals in Ethiopia, found that they scored 80% or more in knowledge, indicating their knowledge was adequate, and respondents who scored above the median point in the attitude towards PU prevention were deemed to have positive attitudes towards PU prevention. This study reported that 68.4% of respondents showed positive attitudes, especially in the area of PU prevention practice. Demarre et al.17 evaluated 145 Belgian medical staff regarding their attitude towards PU prevention. They found that 81% of them exhibited a positive attitude towards PU prevention, but unlike the results of this study, they thought that the prevention of PU should be a priority. Different outcomes on the nurses' knowledge were also found from several other studies. For example, Lawrence and colleagues found that more than 80% of 827 clinicians demonstrated a high level of knowledge, and 90% of them answered more than half of the question items correctly. Kaddourah and colleagues' study also showed that more than 73% of 105 nurse participants had sufficient knowledge. The analysis results of this study may have been similar to an existing study in Korea,18 in that nurses were found to be inadequate in knowledge on PU classification, assessment of PU risk, and preventive strategy to reduce pressure and shearing from the level of PU prevention and need to be properly educated to enrich their insufficient knowledge. Based on her findings, the researcher suggests that nurses need to have education that can help complement their insufficiency in such knowledge.
According to performance of preventing PU, the following findings may also have provided the foundation that the results of this study are somewhat identical to a previous study19: the majority of respondents said they are assessing PU risk factors periodically but are not checking the PU prevention nursing plan properly as instructed, and most of respondents also replied that they are just examining the PU prevention nursing plan merely to review the nursing plan rather than the patient's condition. However, we also found it necessary to give nurses specific and precise guidelines on why and when they have to change the PU prevention nursing plan.
Respondents in this study said the implementation of strategy for PU prevention is an important part of PU nursing care practice, while only a small number of nurses responded that they change the PU prevention nursing plan when PUs develop in patients. This finding is believed to be comparable with those of an existing study.20 Through this study, it is necessary to assess whether preventive care is appropriate and to train the need to revise the plan in case a PU occurs. We would also like to stress that nurses need to be properly educated regarding why the PU prevention nursing plan has to be changed and what kind of PU prevention nursing plan is needed in case a PU develops in patients.
4.1. Study limitation
This study aimed at evaluating Korean nurses' knowledge, attitude, and performance in association with PU prevention. It is difficult to generalise the results to the entire Korean nursing population because these data were obtained from a limited number of Korean nurses in long‐term care facilities. Further studies will be required because the correlation between knowledge, attitudes, and performance of PU prevention have not been analysed. The study will also need further research because the correlation among knowledge, attitudes, and performance of PU prevention was not found.
5. CONCLUSION
This study attempted to identify basic data to develop guideline and education programmes that fit nurses of long‐term care facilities in Korea based on findings regarding their knowledge, attitudes, and level of performance of PU prevention. In this study, nurses scored a 60.1% correct rate, showing that they are generally lacking the knowledge on PU prevention. On the other hand, the attitude towards PU prevention was found to be positive. When it comes to performing PU preventive care, nurses evaluate all patients at risk of PUs but failed to act correctly at a time when re‐assessment and nursing plans had to be changed.
In conclusion, appropriate protocols, education programmes, and an environment that makes it possible to provide continuing education should be created to prevent PUs. Material, time, and human resourses should also be invested to develop a positive attitude towards PU prevention and promote active implementation,
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
ACKNOWLEDGEMENTS
This research was supported by the Korea Institute for Health Accreditation. We thank all the committee members of the Korean Association of Wound Ostomy Continence Nurses for supporting this study and the all nurses of long‐term care facilities who participated in the continuing education programme conducted by the Korean Association of Wound Ostomy Continence Nurses.
Kim JY, Lee YJ. A study on the nursing knowledge, attitude, and performance towards pressure ulcer prevention among nurses in Korea long‐term care facilities. Int Wound J. 2019;16(Suppl. 1):29–35. 10.1111/iwj.13021
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