Analysis of the Current Status of Nurses’ Knowledge of Pressure Injuries and Factors Influencing It in Shaanxi Province, China: A Cross-Sectional Study

Figures & data

Table 1 One-Way Analysis of General Information of Survey Respondents and Caregiver’s Knowledge Score on Pressure Injuries (n=16,599)

Sports Event	Number of Persons (n)	Proportion (%)	Pressure Injury Knowledge Questionnaire Score	t/F value	P-value
Distinguishing between the sexes
Male	419	2.52	41.89±11.85	−4.985	<0.001
Daughter	16,180	97.48	44.38±10.06
Hospital level
Grade 3A	7714	46.47	44.98±9.82	22.940	<0.001
Grade 3B	491	2.96	47.13±8.10
Grade C	12	0.07	37.92±11.50
Grade 2A	7776	46.85	43.38±10.40
Grade 2B	583	3.51	45.98±10.34
Grade A	14	0.08	42.36±7.94
Class A (B)	2	0.01	47.50±6.36
Grade C	7	0.04	40.86±8.19
Administrative division
ICU	964	5.81	45.77±9.57	39.111	<0.001
Emergency department	1022	6.16	43.19±10.17
Geriatrics	414	2.49	45.87±9.47
Neurology	1334	8.03	46.15±9.01
Rehabilitation department	390	2.35	46.24±7.73
Gynaecology	792	4.77	40.77±12.08
Neonatology	272	1.64	40.14±11.92
Neurosurgery	3451	20.79	45.26±9.31
General medicine	4325	26.06	44.69±9.84
(sth. or sb) else	3635	21.90	42.96±10.87
Title
Physiotherapists	4194	25.27	42.88±10.33	85.611	<0.001
Physiotherapists	7873	47.43	43.92±10.09
Nurse practitioner-in-charge	4034	24.30	45.96±9.67
Associate Chief Nurse	479	2.89	49.46±8.62
Chief Nurse	19	0.11	51.05±8.82
Working hours
Less than 1 year	798	4.81	43.01±10.00	32.376	<0.001
1–5 years	4592	27.66	43.88±10.11
>5 years - <10 years	5026	30.28	43.85±10.30
10 years - <15 years	3699	22.28	44.32±10.29
15 years - <20 years	1131	6.81	45.83±9.57
≥ 20 years	1353	8.15	47.10±8.80
Highest level of education
Vocational secondary school	158	0.95	42.76±10.06	33.863	<0.001
Three-year college	5308	31.98	43.07±10.06
Undergraduate (adjective)	11,098	66.86	44.92±10.08
Bachelor’s degree	32	0.19	50.09±11.19
Doctoral	3	0.02	41.33±6.03
Is a wound stoma specialist nurse
Be	276	1.66	47.86±9.60	−5.867	<0.001
Clogged	16,323	98.34	44.26±10.11
Date of last lecture on pressure ulcers
Within 1 year	8461	50.97	46.02±9.16	228.061	<0.001
Greater than 1 year but less than 2 years	3134	18.88	44.73±9.08
2–3 years	1567	9.44	43.40±9.88
4 years or more	890	5.36	41.70±10.94
Never before	2547	15.51	39.63±12.24
Most recent reading of literature or book on pressure ulcers
Within 1 year	10,649	64.15	45.65±9.30	232.344	<0.001
Greater than 1 year Less than 2 years	2573	15.50	44.12±9.29
2–3 years	1154	6.95	42.63±10.22
4 years or more	990	5.96	41.42±9.99
Never before	1437	8.66	37.79±13.61
Ever looked up information about pressure ulcers on the internet
Be	13,713	82.61	45.14±9.41	23.251	<0.001
Clogged	2886	17.39	40.40±12.21
Have you read the International Guidelines for the Prevention and Treatment of Pressure Ulcers?
Be	4864	29.30	46.18±9.36	15.339	<0.001
Clogged	11,735	70.70	43.55±10.31

Table 2 Total and Dimensional Scores of the Pressure Injury Knowledge Questionnaire

Sports Event	Entry	Score (Points)	Correctness (%)
Totals	72	44.32±10.11	61.56±14.05
Risk factors/prevention	28	18.72±3.98	66.87±14.23
Pressure ulcer staging	20	11.99±3.46	59.95±16.83
Wound Description	24	13.67±4.04	56.70±21.68

Note: Percentage correct (%) = score / full score x 100%.

Table 3 Top 10 Scoring Entries on the Pressure Injury Knowledge Questionnaire

Entry (in a Dictionary, Encyclopedia etc)	Score ()
15. Dragging the patient in bed increases friction.	0.94±0.239
8. For bedridden patients the position should be changed according to risk factors and the characteristics of the support surface.	0.94±0.246
18. There should be a bowel care plan for incontinent patients.	0.93±0.252
5. Chair cushions should be placed on patients who are wheelchair users.	0.92±0.276
61. The nurse should avoid pressing on reddened skin when the patient is turned.	0.92±0.278
28. Individuals at risk for pressure injuries should have a nutritional assessment (eg, weight, nutritional intake, blood tests).	0.91±0.288
16. Patients who cannot tolerate large positional changes may undergo small positional changes.	0.90±0.297
23. Home care facilities require special consideration of the choice of support surfaces.	0.89±0.317
46. Patients with spinal cord injuries need to know about pressure injury prevention and self-care.	0.89±0.31
58. Selection of appropriately sized devices for obese patients has the potential to avoid pressure injuries.	0.89±0.317

Table 4 Entries with the Bottom 10 Scores on the Pressure Injury Knowledge Questionnaire

Entry (in a Dictionary, Encyclopedia etc)	Score ()
50. Patients who are immobile but can communicate can be told to change their center of gravity position every 30 minutes while sitting in a chair.	0.15±0.362
43. Massage of bony elevations is essential for skin care.	0.17±0.376
10. Pressure injuries progress in a linear fashion from stage I to stages II, III, and IV.	0.18±0.382
25. Loop-shaped pressure-relief devices help prevent pressure damage.	0.21±0.405
Stage 6.3 pressure injuries are those involving partial cortical loss of the epidermis and/or dermis.	0.25±0.436
66. Pressure injuries can be cleaned with potable water.	0.26±0.437
33. Separate employee education and training may reduce the incidence of pressure injuries.	0.27±0.444
53. Support surfaces should be selected only in consideration of the patient’s level of risk for pressure injuries.	0.28±0.449
13. The aim of palliative care is wound healing.	0.28±0.451
37.3 Stage 3 pressure injuries may expose bone, tendon, or muscle.	0.29±0.455

Table 5 Assignment of Independent Variables

Variant	Assign a Value to Something
Distinguishing between the sexes	1=Male; 2=Female
Hospital level	1=Triple A; 2=Triple B; 3=Triple C; 4=Di A; 5=Di B; 6=Di C; 7=I A; 8=I B; 9=I C
Unit (eg intensive care unit)	Setting dummy variables to “ICU” as reference
Title	1=Nurse; 2=Nurse Practitioner; 3=Nurse Practitioner-in-Charge; 4=Associate Nurse Practitioner; 5=Chief Nurse Practitioner
Working hours	1 = <1 year; 2 = 1 to 5 years; 3 = >5 to 10 years; 4 = 10 to <15 years; 5 = 15 to <20 years; 6 = ≥20 years
Highest level of education	1=Secondary; 2=College; 3=Bachelor’s degree; 4=Master’s degree; 5=Doctoral degree
Is a wound stoma specialist nurse	1=Yes; 2=No
Date of last lecture on pressure ulcers	1 = <1 year; 2 = 1 to 2 years; 3 = 2 to 3 years; 4 = >4 years; 5 = never
Most recent reading of literature or book on pressure ulcers	1 = <1 year; 2 = 1 to 2 years; 3 = 2 to 3 years; 4 = >4 years; 5 = never
Ever looked up information about pressure ulcers on the internet	1=Yes; 2=No
Have you read the International Guidelines for the Prevention and Treatment of Pressure Ulcers?	1=Yes; 2=No
Pressure Injury Knowledge Questionnaire Score	Original value carried over

Table 6 Multiple Linear Regression Analysis of Factors Influencing Nurses’ Level of Knowledge About Stress Injuries

Mould	Unstandardized Coefficient		Standardized Coefficient	t	P
	B	Standard Error	Beta
(Constant)	41.931	0.532	–	78.822	<0.001
Distinguishing between the sexes	−1.777	0.478	−0.028	−3.715	<0.001
Hospital level	−0.163	0.051	−0.025	−3.215	0.001
Title	1.631	0.100	0.127	16.312	<0.001
Highest Level of education	0.452	0.162	0.022	2.801	0.005
Is a wound stoma specialist nurse	1.638	0.583	0.021	2.810	0.005
Date of last lecture on pressure ulcers	−0.865	0.059	−0.126	−14.627	<0.001
Most recent reading of literature or book on pressure ulcers	−0.894	0.070	−0.113	−12.753	<0.001
Ever looked up information about pressure ulcers on the internet	2.631	0.210	0.099	12.511	<0.001
Have you read the International Guidelines for the Prevention and Treatment of Pressure Ulcers?	0.743	0.172	0.033	4.324	<0.001
Administrative division*
Emergency department	−1.402	0.314	−0.033	−4.469	<0.001
Gynaecology	−3.137	0.354	−0.066	−8.867	<0.001
Neonatology	−4.040	0.587	−0.051	−6.885	<0.001
(sth. or sb) else	−1.628	0.186	−0.067	−8.763	<0.001

Notes: *Using ICU as reference; R² = 0.112, R²_adj = 0.112, F = 161.337, p < 0.001; “–” means no such data; only statistically significant variables are presented.