Wanwan Fang,1,2 Wenyan Pan,3 Xiao Liu,3 Jingyi Li,4 Qi Zhang,1 Wei Qin1 

1Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2School of Nursing, Fudan University, Shanghai, People’s Republic of China; 3Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 4Respiratory Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

Correspondence: Wei Qin, Email qin.wei@zs-hospital.sh.cn Qi Zhang, Email zhang.qi1@zs-hospital.sh.cn

Background: Pressure injury (PI) is a major concern in ICUs, where multiple risk factors contribute to its development. ICU nurses are vital in PI prevention, a key element of patient safety and care quality.
Aim: Explore ICU nurses’ perceptions of PI prevention in prone-positioned patients across nine major hospitals in Shanghai, China, and to evaluate their knowledge and attitudes toward PI prevention.
Design: A multicenter cross-sectional study.
Methods: Convenience sampling recruited 252 ICU nurses from nine hospitals in Shanghai between July 31 and August 25, 2024. Participants completed a questionnaire assessing their perceptions of PI prevention in prone-positioned patients. Their knowledge and attitudes were evaluated using the Pressure Ulcer Knowledge Assessment Tool version 2.0 (PUKAT 2.0) and the Attitudes toward Pressure Ulcer Prevention instrument (APuP). Statistical analyses included Pearson correlation, t-tests, ANOVA, and multivariate regression.
Results: ICU nurses showed a positive perception of PI prevention in prone-positioned patients. The mean knowledge score was 8.45 ± 2.55 (40.24%, ≥ 60% satisfactory), while the mean attitude score was 39.39 ± 4.88 (75.75%, ≥ 75% satisfactory). Knowledge and attitudes were significantly positively correlated (r = 0.215; p < 0.05). Demographic factors such as gender, age, and ICU experience significantly influenced knowledge and attitudes (all p < 0.05). Nurses with a master’s degree and those who had been primary nurses for prone-ventilated patients had higher knowledge scores. Additionally, nurses with 6– 15 years of experience showed more favorable attitudes toward PI prevention.
Conclusion: Although ICU nurses had a positive perception of PI prevention in prone-positioned patients, their knowledge was insufficient, and their attitudes were moderate. To address these gaps, healthcare administrators should implement targeted strategies and update evidence-based protocols for PI prevention in prone-ventilated patients. Improving nurses’ knowledge and fostering a proactive attitude can enhance clinical practices and patient outcomes.

Keywords: pressure injury, prone positioning, perception, knowledge, attitude, nurses