Intensive care nurses’ knowledge of pressure injury prevention

Intensive care nurses’ knowledge of pressure injury prevention | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intensive care nurses’ knowledge of pressure injury prevention Ntombifikile Klaas, Ricki-Lee Serebro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4889364/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Dec, 2024 Read the published version in BMC Nursing → Version 1 posted 16 You are reading this latest preprint version Abstract 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 Background 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 patients 5 . 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 unsatisfactory 16 .. 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. Methods 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. Results 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 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 Discussion 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. Conclusion 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. Abbreviations CCSSA Critical Care Society of South Africa ICU Intensive care unit NPUAP National Pressure Ulcer Advisory Panel PI Pressure injuries PIP Pressure injury Prevention PUKAT Pressure Ulcer Knowledge Assessment Tool. Declarations 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. References 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. 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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\u0026ndash;40% for acute care settings\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. A meta-analysis on the global prevalence of PI suggested 12.8%, with a hospital-acquired pressure injury (HAPI) incidence of 8.4% \u003csup\u003e3\u003c/sup\u003e. This makes pressure injuries a major difficult-to-treat health problem, which is often expensive and complex.\u003c/p\u003e \u003cp\u003eCritically ill patients are more likely to develop pressure injuries than patients in general wards \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Furthermore, ICU patients are 3.8 times more likely to develop a PI than non-intensive care patients\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Severe illness, comorbidities, restricted movement and bed rest complications predisposes ICU patients to a higher risk of developing PI \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough 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 \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. 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 \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. According to international literature, it has been identified that nurses\u0026rsquo; knowledge of PIP is poor \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe 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 \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Similarly, a study in Belgium found that the knowledge of nurses about the prevention of pressure injuries was inadequate \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Additionally, the results of a South African study revealed that the knowledge and practices of nurses on pressure injury prevention were unsatisfactory\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.. The findings of a systematic review on the nurse\u0026rsquo;s knowledge of pressure injury prevention indicated that the nurses have poor knowledge of PIP irrespective of their geographic location \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHospital-acquired pressure injuries remain a significant complication of hospitalisation, despite increased awareness and knowledge \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Common barriers to implementing pressure injury prevention guidelines are knowledge deficit and a negative attitude towards preventing pressure injuries \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. 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 \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eKnowledge of pressure injuries, including risk, prevention, staging, and treatment, is essential in preventing pressure injuries and their associated complications \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. 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 \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Identifying gaps in knowledge and evaluating nurses' attitudes and practices about the importance of preventing and managing pressure injuries is vital \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study aimed to describe intensive care nurses\u0026rsquo; knowledge of pressure injury prevention.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional design was used in this study \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eData 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePopulation, sample and sampling\u003c/h2\u003e \u003cp\u003eThe 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 \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, after setting the indicator percentage at 0.50, the margin of error at 5%, and the confidence interval at 95%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eInstrument\u003c/h2\u003e \u003cp\u003eA 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 \u003csup\u003e15\u003c/sup\u003e and revised in 2017 \u003csup\u003e19\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe 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 \u003csup\u003e25\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eEthical clearance and permission to conduct the study were obtained from the university\u0026rsquo;s Human research committee (\u003cb\u003eM200364\u003c/b\u003e), as well as the hospital management where the study was conducted. Participants\u0026rsquo; 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData 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.\u003c/p\u003e \u003cp\u003eData 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.\u003c/p\u003e \u003cp\u003eHowever, 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData 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.\u003c/p\u003e \u003cp\u003eNormally 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.\u003c/p\u003e \u003cp\u003eA 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\u0026trade; version 13.2 was the statistical software used to analyse the data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003eIn total, 101 surveys were distributed, and the response rate was 100%. Most of the participants (26.73%, n\u0026thinsp;=\u0026thinsp;27) were between the ages of 30 and 39 years and the majority were female (89.1%, n\u0026thinsp;=\u0026thinsp;90). Just over half (51.49%, n\u0026thinsp;=\u0026thinsp;52) held postgraduate qualifications and 31.68% (n\u0026thinsp;=\u0026thinsp;32) had 6 to 10 years of ICU experience. Trauma ICU had majority of the respondents (35.64%, n\u0026thinsp;=\u0026thinsp;36). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes these results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the respondents (N\u0026thinsp;=\u0026thinsp;101)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.89%\u003c/p\u003e \u003cp\u003e\u003cb\u003e89.11%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e20 to 29yrs\u003c/p\u003e \u003cp\u003e30 to 39yrs\u003c/p\u003e \u003cp\u003e40 to 49yrs\u003c/p\u003e \u003cp\u003e50 to 59yrs\u003c/p\u003e \u003cp\u003e60 to 65yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e27\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.85%\u003c/p\u003e \u003cp\u003e\u003cb\u003e26.73%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e25.74%\u003c/p\u003e \u003cp\u003e25.74%\u003c/p\u003e \u003cp\u003e6.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest level of education\u003c/p\u003e \u003cp\u003eUndergraduate diploma/degree\u003c/p\u003e \u003cp\u003ePostgraduate diploma/degree\u003c/p\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003cp\u003e52\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.55%\u003c/p\u003e \u003cp\u003e\u003cb\u003e51.49%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e3.96%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensive care experience\u003c/p\u003e \u003cp\u003e6 months to 1 year\u003c/p\u003e \u003cp\u003e2 to 5 years\u003c/p\u003e \u003cp\u003e6 to 10 years\u003c/p\u003e \u003cp\u003e11 to 15 years\u003c/p\u003e \u003cp\u003e16 to 20 years\u003c/p\u003e \u003cp\u003e\u0026gt;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003cp\u003e32\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.83%\u003c/p\u003e \u003cp\u003e23.76%\u003c/p\u003e \u003cp\u003e\u003cb\u003e31.68%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e11.88%\u003c/p\u003e \u003cp\u003e8.91%\u003c/p\u003e \u003cp\u003e6.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent position\u003c/p\u003e \u003cp\u003eProfessional nurse\u003c/p\u003e \u003cp\u003eTrauma trained/experienced\u003c/p\u003e \u003cp\u003eICU trained/experienced\u003c/p\u003e \u003cp\u003eUnit manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e52\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.64%\u003c/p\u003e \u003cp\u003e9.90%\u003c/p\u003e \u003cp\u003e\u003cb\u003e51.49%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e2.97%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of ICU\u003c/p\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003cp\u003eCardio-thoracic\u003c/p\u003e \u003cp\u003eMultidisciplinary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e35.64%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e13.86%\u003c/p\u003e \u003cp\u003e16.83%\u003c/p\u003e \u003cp\u003e\u003cb\u003e33.66%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of Pressure Injury Prevention and Management\u003c/h2\u003e \u003cp\u003eKnowledge of intensive care nurses was measured using the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e 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 \u0026ldquo;Prevention of pressure injuries\u0026rdquo; had the lowest percentage of correct answers (25%) followed by \u0026ldquo;Classification and observation\u0026rdquo; (39.5%), respectively. Risk assessment\u0026rdquo; and \u0026ldquo;Nutrition\u0026rdquo; were the themes in which respondents had the highest scores, 100% and 50% respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntensive care Nurses' knowledge of Pressure Injury Prevention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThemes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAetiology and development (items\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.81(1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClassification and observation (items\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.58 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk assessment (items\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition (items\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.51 (0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventative measures to reduce the amount of pressure (items\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (11\u0026thinsp;\u0026minus;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecific patient groups (items\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96 (0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEqual to or more than 60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEqual to or lower than 59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with knowledge of prevention and prevention of pressure injuries\u003c/h2\u003e \u003cp\u003eBy 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.\u003c/p\u003e \u003cp\u003eThe intensive care nurses with 2\u0026ndash;5 years of experience were more likely to score high on the PUKAT questionnaire (6.38, 95% CI 9.70\u0026ndash;5.45; p\u0026thinsp;=\u0026thinsp;0.039) in comparison to nurses with 6\u0026ndash;10 years of experience.\u003c/p\u003e \u003cp\u003e The adjusted multiple linear regression models show intensive care nurses aged 20\u0026ndash;29 years were more likely to score higher in the PUKAT questionnaire (9.69, 95% CI 2.61\u0026ndash;16.77) than nurses aged 30\u0026ndash;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\u0026thinsp;=\u0026thinsp;0.014) than nurses with a postgraduate qualification.\u003c/p\u003e \u003cp\u003eThe 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\u0026thinsp;=\u0026thinsp;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\u0026ndash;28.24; p\u0026thinsp;=\u0026thinsp;0.016) in comparison to intensive care with an additional qualification in Critical Care or experienced nurses. These results are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between nurses\u0026rsquo; demographics and knowledge of pressure injury prevention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnadjusted Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.39 (-0.16- 14.95)\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.55 (1.22\u0026ndash;1.97)\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.90 (-1.84- 13.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.69 (2.61\u0026ndash;16.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.34 (-7.94-5.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.42 (7.27\u0026ndash;4.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.04 (-4.56-8.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.02 (-4.20\u0026ndash;10.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68 (-9.51- 10.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.58 (-7.14\u0026ndash;14.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003eUndergraduate diploma/degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.4(-10.08-0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.024*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.40 (-8.03- 3.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate diploma/degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.92 (0.02\u0026ndash;23.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.00 (2.90-25.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience\u003c/p\u003e \u003cp\u003e6 months-1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-9.18(-15.90-2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.71(-18.53- -2.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.38 (0.33\u0026ndash;12.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.039*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.89 (-3.41\u0026ndash;9.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.13 (-9.70-5.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.85 (-9.25-5.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.76 (-5.68-11.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.79 (-9.64-8.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73 (-8.61-10.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.97 (-10.65-8.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003cp\u003eProfessional Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-7.44 (-12.25- -2.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.44 (-8.03-5.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnit manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (2.84\u0026ndash;29.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.58 (2.92\u0026ndash;28.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCronbach alpha coefficients\u003c/h2\u003e \u003cp\u003eThe Cronbach alpha coefficients show that there was very poor (Cronbach alpha coefficient\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.50) consistency in any of the themes in the PUKAT 2.0 questionnaire responses by the respondents \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes this information.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInternal consistency of the items in the PUKAT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCronbach alpha coefficient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme One: Etiology and development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme Two: Classification and observation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme Three: Risk assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme Four: Nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme Five: Preventative measures to reduce the amount of pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme Six: Specific patient groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study intended to assess the intensive care nurses\u0026rsquo; knowledge of pressure injury prevention. Data was collected using the Knowledge Assessment Tool (PUKAT 2.0) on a sample of 101 (n\u0026thinsp;=\u0026thinsp;101) nurses working in four adult ICUs at a public hospital in Gauteng Province, South Africa.\u003c/p\u003e \u003cp\u003eThe PUKAT 2.0 questionnaire is the most up-to-date knowledge assessment tool on pressure injury prevention \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. All items of the tool were formulated according to the most recent evidence-based guidelines \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Also, cases and pictures were added to evaluate theoretical knowledge and practical knowledge \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeveral studies conducted in different countries over the past two decades have revealed that the nurse\u0026rsquo;s knowledge of pressure injury prevention is poor \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In this study, the overall mean total score for ICU nurses\u0026rsquo; 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 \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. While these scores are higher than 38.2% and 28.9%, respectively reported from studies using the PUKAT in Turkey \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e and Belgium \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, they are still unsatisfactory. One study conducted in Belgium \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e reported a knowledge score of 49.3% for registered nurses. Several other studies conducted in different countries like Italy (51.1%) \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, Jordan (54.9%) \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, Belgium (50.7%)\u003csup\u003e9\u003c/sup\u003e, Sweden (59.3%) \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e reported low mean total knowledge scores.\u003c/p\u003e \u003cp\u003eOnly six (5.9%) out of 101 (n\u0026thinsp;=\u0026thinsp;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 \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e conducted on 150 nurses, determined a knowledge score of 58% while the Korean study \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e 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.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e and De Meyer et al. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e as well as a Jordanian study by Batiha \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e where the respondents obtained scores of 52%, 50.7% and 54.9%, respectively.\u003c/p\u003e \u003cp\u003eIn a recent systematic review and meta-analysis conducted with 4766 nurses, nursing students and assistant nurses, Dalvand et al. \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e 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%.\u003c/p\u003e \u003cp\u003eIn our study, the lowest scores were found in the following themes: \"\u003cb\u003eclassification and observation\"\u003c/b\u003e with \u003cb\u003escores of 39.5%\u003c/b\u003e and \"\u003cb\u003eprevention of pressure injuries\"\u003c/b\u003e with \u003cb\u003escores of 25%.\u003c/b\u003e The highest scores were found in \"\u003cb\u003erisk assessment\"\u003c/b\u003e \u003cb\u003e(100.0%)\u003c/b\u003e and \"\u003cb\u003enutrition\"\u003c/b\u003e \u003cb\u003e(50.0%).\u003c/b\u003e These findings are similar to those of a Belgian \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and Jordanian study \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBy 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 \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e analysed the influence of professional experience on nurses\u0026rsquo; knowledge and found statistically significant differences between professional nurses with 2\u0026ndash;5 and 5\u0026ndash;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.\u003c/p\u003e \u003cp\u003eIntensive care nurses with 2\u0026ndash;5 years of experience were more likely to score high on the PUKAT questionnaire (6.38, 95% CI 9.70\u0026ndash;5.45; p\u0026thinsp;=\u0026thinsp;0.039) in comparison to those with 6\u0026ndash;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 \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e The adjusted multiple linear regression models show intensive care nurses aged 20\u0026ndash;29 years were more likely to score higher in the PUKAT questionnaire (9.69, 95% CI 2.61\u0026ndash;16.77) those aged 30\u0026ndash;39 years. Significant higher mean scores for younger age group participants was also found in the Saudi Arabian study \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. This may be explained by the short period between graduation and starting to practice as a nurse.\u003c/p\u003e \u003cp\u003eIntensive 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\u0026thinsp;=\u0026thinsp;0.014) than those with a postgraduate degree or diploma. The Belgian \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, Italian \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and Spanish study \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e found a similar correlation between educational background and knowledge.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe researchers acknowledge the following limitations:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe study was only conducted in one hospital, in one city and therefore the findings cannot be generalised to other populations.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eA relatively small sample size was utilised (n\u0026thinsp;=\u0026thinsp;101).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eA quantitative design was used. This limits the participants\u0026rsquo; responses.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eTherefore, the study\u0026rsquo;s findings can only be generalised if it is replicated on a larger scale, involving more ICUs, in other hospitals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study assessed the intensive care nurse\u0026rsquo;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.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCSSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCritical Care Society of South Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNPUAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Pressure Ulcer Advisory Panel\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePressure injuries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePIP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePressure injury Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePUKAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePressure Ulcer Knowledge Assessment Tool.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRS: 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: 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.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe article does not contain any individual details, and therefore, consent for publication is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ede Sousa RC, Faustino AM. Nurses\u0026rsquo; understanding about the pressure injury prevention and care/Conhecimento de enfermeiros sobre preven\u0026ccedil;\u0026atilde;o e cuidados de les\u0026atilde;o por press\u0026atilde;o. 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Risk Management and Healthcare Policy. 2021 Oct 11:4257-67.\u003c/li\u003e\n\u003cli\u003eClark M, Bours GJ, Delfoor T. Summary report on the prevalence of pressure ulcer.\u003c/li\u003e\n\u003cli\u003eBeeckman D, Vanderwee K, Demarr\u0026eacute; 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.\u003c/li\u003e\n\u003cli\u003eMalinga S, Dlungwane T. Nurses' Knowledge, Attitudes and Practices regarding Pressure Ulcer Prevention in the Umgungundlovu District, South Africa. Africa Journal of Nursing \u0026amp; Midwifery. 2020 Jul 1;22(2).\u003c/li\u003e\n\u003cli\u003eDalvand S, Ebadi A, Gheshlagh RG. Nurses\u0026rsquo; 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.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"18\"\u003e\n\u003cli\u003eWong 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.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"19\"\u003e\n\u003cli\u003eManderlier B, Van Damme N, Vanderwee K, Verhaeghe S, Van Hecke A, Beeckman D. Development and psychometric validation of PUKAT 2\u0026middot; 0, a knowledge assessment tool for pressure ulcer prevention. International Wound Journal. 2017 Dec;14(6):1041-51.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"20\"\u003e\n\u003cli\u003eWu 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.\u003c/li\u003e\n\u003cli\u003ePieper B, Zulkowski K. The Pieper-Zulkowski pressure ulcer knowledge test. Advances in skin \u0026amp; wound care. 2014 Sep 1;27(9):413-20.\u003c/li\u003e\n\u003cli\u003eWound O. WOCN 2016 guideline for prevention and management of pressure injuries (ulcers): an executive summary. Journal of Wound Ostomy \u0026amp; Continence Nursing. 2017 May 1;44(3):241-6.\u003c/li\u003e\n\u003cli\u003ePolit, D.F. and Beck, C.T. (2017) Nursing Research: \u003cem\u003eGenerating and Assessing Evidence for Nursing Practice\u003c/em\u003e. 10th Edition, Wolters Kluwer Health, Philadelphia.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"24\"\u003e\n\u003cli\u003ePolit D, Beck C. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams \u0026amp; Wilkins; 2020 Dec 30.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"25\"\u003e\n\u003cli\u003eRaosoft (2004) Raosoft Sample Size Calculator. Raosoft, Inc., Seattle.\u003cbr /\u003ehttp://www.raosoft.com/samplesize.html. Accessed 09 August 2024.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"26\"\u003e\n\u003cli\u003eTirgari B, Mirshekari L, Forouzi MA. Pressure injury prevention: knowledge and attitudes of Iranian intensive care nurses. Advances in skin \u0026amp; wound care. 2018 Apr 1;31(4):1-8.\u003c/li\u003e\n\u003cli\u003eTavakol M, Dennick R. Making sense of Cronbach's alpha. International journal of medical education. 2011; 2:53.\u003c/li\u003e\n\u003cli\u003eGunningberg L, M\u0026aring;rtensson G, Mamhidir AG, Florin J, Muntlin Athlin \u0026Aring;, B\u0026aring;\u0026aring;th C. Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. 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Critical care nurses\u0026rsquo; knowledge, attitudes, and perceived barriers towards pressure injuries prevention. International Journal of Advanced Nursing Studies. 2018;7(2):117.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"33\"\u003e\n\u003cli\u003eTulek 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.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"34\"\u003e\n\u003cli\u003eKim 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.\u003c/li\u003e\n\u003cli\u003ePancorbo‐Hidalgo PL, Garc\u0026iacute;a‐Fern\u0026aacute;ndez FP, L\u0026oacute;pez‐Medina IM, L\u0026oacute;pez‐Ortega J. Pressure ulcer care in Spain: nurses\u0026rsquo; knowledge and clinical practice. Journal of Advanced Nursing. 2007 May;58(4):327-38.\u003c/li\u003e\n\u003cli\u003eSuva 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.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"37\"\u003e\n\u003cli\u003eKaddourah 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.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pressure injury, prevention, knowledge, intensive care unit","lastPublishedDoi":"10.21203/rs.3.rs-4889364/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4889364/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePressure 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\u0026rsquo; knowledge of PI prevention.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean knowledge of nurses (N\u0026thinsp;=\u0026thinsp;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\u0026rdquo; (25%) and \u0026ldquo;classification and observation\u0026rdquo; (39.5%), respectively. The higher level of education (14.00; 95% CI 2.90-25.11; p\u0026thinsp;=\u0026thinsp;0.014), seniority (15.58; 95% CI 2.92\u0026ndash;28.24; p\u0026thinsp;=\u0026thinsp;0.016) position, and years of experience (6.38; 95% CI 9.70\u0026ndash;5.45; p\u0026thinsp;=\u0026thinsp;0.039), were statistically significant to predict appropriate prevention and management of pressure injuries.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Intensive care nurses’ knowledge of pressure injury prevention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-19 18:42:45","doi":"10.21203/rs.3.rs-4889364/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-05T09:15:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-05T05:52:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87249581613522879566383613243970399440","date":"2024-09-01T21:33:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-30T18:23:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76526167084830669239292778373041496986","date":"2024-08-30T07:56:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159774085765403864940830322464757201119","date":"2024-08-29T11:46:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-29T11:26:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135275586994625899830251266508934841215","date":"2024-08-29T10:15:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173185625450043586619559223865888427121","date":"2024-08-29T06:44:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280973427525488006554251632376546504239","date":"2024-08-27T13:15:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230634389818253280909570353164591965029","date":"2024-08-27T11:08:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-27T08:15:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-21T07:01:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-20T07:30:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-20T07:30:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-08-10T00:08:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d371b449-1175-4af0-844e-7e7e849b858f","owner":[],"postedDate":"September 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:00:55+00:00","versionOfRecord":{"articleIdentity":"rs-4889364","link":"https://doi.org/10.1186/s12912-024-02533-4","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2024-12-02 15:57:18","publishedOnDateReadable":"December 2nd, 2024"},"versionCreatedAt":"2024-09-19 18:42:45","video":"","vorDoi":"10.1186/s12912-024-02533-4","vorDoiUrl":"https://doi.org/10.1186/s12912-024-02533-4","workflowStages":[]},"version":"v1","identity":"rs-4889364","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4889364","identity":"rs-4889364","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}