Assessing the Disparities in Pressure Injury Prevention Knowledge and Practices Among Critical Care Unit Nurses in Government and Private Hospitals in Madinah City, Saudi Arabia
Abstract
Objective: To examine the level of knowledge and practice regarding pressure injury prevention in the critical care units of nurses working in Medina City, Saudi Arabia.
Material and Methods: A cross-sectional quantitative study design was applied. A total of 598 staff nurses working in King Fahad Hospital and the Saudi German Hospital, Madina, completed the questionnaires. Data were collected using the pressure injury prevention knowledge questionnaire and the pressure injury prevention practices questionnaire. Statistical analysis was conducted using descriptive statistics, Chi-square, independent sample t-test, and multiple linear regression inferential analysis of IBM SPSS version 27.
Results: Nurses’ total knowledge of pressure ulcer prevention was moderate (17.31±2.86), within the possible score of 22 points. The mean practices of pressure injury prevention among the nurses were reported at 56.64 (S.D.=3.095). The study was found to be clinically significant, but there were no statistically significant differences in the mean pressure injury knowledge scores between those working in private hospitals and those in the public hospitals (17.41±2.82 and 17.26±2.88, respectively, t=0.631, df=596, p-value=0.528). However, the pressure injury practices among nurses in private hospitals were significantly better (p-value=0.004) than those from governmental hospitals (57.17±2.718 vs 56.39±3.234, respectively). Knowledge and practices of pressure injury prevention in government and private hospitals varied according to many factors, including age, duration of employment, formal training, marital status, and level of education (p-value<0.05).
Conclusion: Nurses in private hospitals showed clinically significantly better preventive practices, spotlighting quality of care differences.
Keywords
Full Text:
PDFReferences
National Institute for Health and Care Excellence (NICE). Pressure ulcers: prevention and management. Clinical guideline [CG179]. [homepage on the Internet]. London: NICE; 2014. [cited 2025, May 20]. Available from: https://www.nice.org.uk/guidance/cg179
Kayser SA, VanGilder CA, Lachenbruch C. Predictors of superficial and severe hospital-acquired pressure injuries: a cross-sectional study using the international pressure ulcer prevalence™ survey. Int J Nurs Stud 2019;89:46-52.
World Health Organization (2023). Patient Safety. [homepage on the Internet]. Geneva: WHO; 2023. [cited 2025 May 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/patient-safety
Mallah Z, Nassar N, Sharara E, Rizk F. Prevalence and incidence of pressure injuries among older people in nursing homes: a systematic review and meta-analysis. J Clin Nurs. 2023;32:6075-87. doi: 10.1111/jocn.16744.
Zhou Q, Li X, Wang Y, Zhao J. Global, regional, and national burden of decubitus ulcers from 1990 to 2021: results from the global burden of disease study. Front Public Health 2025;13:1494229. doi: 10.3389/fpubh.2025.1494229.
Tayyib N, Coyer F, Lewis P. Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study. International wound journal. 2016;13:912-9.
Al-Zahrani HA. Prevalence of pressure ulcers among patients receiving home healthcare in Makkah, Saudi Arabia. London J Med Health Res 2022;22:45-52.
Aljezawi M, Tubaishat A, Al Qadire M. Pressure ulcers in intensive care units: a prospective cohort study of their incidence and associated factors in Jordan and Saudi Arabia. Risk Manag Healthc Policy 2021;14:129-39. doi: 10.2147/RMHP.S290045.
Amirah MFY, Rasheed AMY, Parameaswari PJ, Awajeh AM, Issa MR, Abdallah M. Pressure injury prevalence and risk factors among adult critically ill patients at a large intensive care unit. J Intensive Crit Care 2019:9. doi: 10.21767/2471-8505.100128.
Alderden J, Rondinelli J, Pepper G, Cummins M, Whitney J. Risk factors for pressure injuries among critical care patients: a systematic review. Int J Nurs Stud 2017;71:97-114.
Chaboyer WP, Thalib L, Harbeck EL, Coyer FM, Blot S, Bull CF, et al. Incidence and prevalence of pressure injuries in adult intensive care patients: a systematic review and meta-analysis. Crit care Med 2018;46:e1074-81.
Rivera J, Donohoe E, Deady-Rooney M, Douglas M, Samaniego N. Implementing a pressure injury prevention bundle to decrease hospital-acquired pressure injuries in an adult critical care unit: an evidence-based, pilot initiative. Wound Manag Prev. 2020;66:20-28.
Zarei E, Madarshahian E, Nikkhah A, Khodakarim S. Incidence of pressure ulcers in intensive care units and direct costs of treatment: Evidence from Iran. J. Tissue Viability 2019;28:70-4.
Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC geriatrics 2018;18:1-1.
Aydın AK, Karadağ A, Gül Ş, Avşar P, Baykara ZG. Nurses’ knowledge and practices related to pressure injury: a cross-sectional study. J Wound Ostomy Continence Nurs 2019;46:117-23.
Saleh D, Camart N, Romo L. Predictors of stress in college students. Frontiers in psychology 2017;8:19.
Sengul T, Karadag A. Determination of nurses’ level of knowledge on the prevention of pressure ulcers: The case of Turkey. J Tissue Viability 2020;29:337-41.
Saleh MY, Papanikolaou P, Nassar OS, Shahin A, Anthony D. Nurses’ knowledge and practice of pressure ulcer prevention and treatment: an observational study. J Tissue Viability 2019;28:210-7.
Jiang L, Li L, Lommel L. Nurses’ knowledge, attitudes, and behaviours related to pressure injury prevention: A large-scale cross-sectional survey in mainland China. J Clin Nurs 2020;29:3311-24.
Tirgari B, Mirshekari L, Forouzi MA. Pressure injury prevention: knowledge and attitudes of Iranian intensive care nurses. Advances in skin & wound care 2018;31:1-8.
Maylor M, Torrance C. Pressure sore survey part 2: nurses’ knowledge. J Wound Care 1999;8:49-52.
Islam MS. Nurses’ knowledge, attitude, and practice regarding pressure ulcer prevention for hospitalized patients at Rajshahi Medical College Hospital in Bangladesh [master’s thesis]. Songkhla (Thailand): Prince of Songkla University; 2010.
Altarawneh WM, Masa’deh R, Hamaideh SH, Saleh AM, Alhalaiqa F. Nurses’ knowledge, attitudes and practices towards palliative care provided to patients diagnosed with cancer. PLOS One 2023;18:e0289317.
Dimanopoulos TA, Chaboyer W, Plummer K, Mickan S, Ullman AJ, Campbell J, Griffin BR. Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: a qualitative analysis. J Adv Nurs 2023.
Abrahams C, Alley H, Downing C. Experiences of newly employed professional nurses regarding their quality of work life at a private hospital in Gauteng. Int J Afr Nurs Sci 2021;15:100362.
Dirgar E, Tosun B, Dokumuş H, Bülbül T. Evaluating nurses’ knowledge of pressure injury prevention: a descriptive study. Adv Skin Wound Care 2022;35:1-6.
Jahanpeyma P, Sajadi SA, Rajai N, Akyol AD. Comparison of challenges of the nursing educational system in Iran and Turkey. Nurse Educ Today 2022;119:105540.
Ven S, Fulbrook P, Burston A, Lovegrove J, Miles SJ. Pressure injury risk assessment for palliative care patients in the acute hospital setting: a scoping review. BMC Palliat Care 2025 25;24:212.
Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, Litchford M, Mitchell P, Moore Z, Pittman J, Sigaudo-Roussel D. Pressure ulcer/injury classification today: an international perspective. J Tissue Viability 2020;29:197-203.
Aca Z, Kırcal-Şahin A, Özdemir A, Kaymakcı YS. Gender stereotypes and professional experiences of female nurses in Türkiye. Front Public Health 2025;13:1538517.
Moncatar TR, Nakamura K, Siongco KL, Seino K, Carlson R, Canila CC, et al. Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study. Human Resources for Health 2021;19:1-4.
Serpa LF, Ortiz MM, Lima AC, Bueno L, Nogueira PC, Ferri C, Santos VL. Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil. Wound Repair Regen 2021;29:79-86.
Ebi WE, Hirko GF, Mijena DA. Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design. BMC Nursing 2019;18:1-2.
Mlambo M, Silén C, McGrath C. Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC nursing 2021;20:1-3.
Zhang YB, He L, Gou L, Pei JH, Nan RL, Chen HX, et al. Knowledge, attitude, and practice of nurses in intensive care unit on preventing medical device–related pressure injury: A cross-sectional study in western China. Int Wound J 2021;18:777-86.
Lv T, Tang A, Yang Y, Wang J. Clinical nurses’ attitudes towards medical device-related pressure injuries and an analysis of relevant influencing factors: A cross-sectional study in China. Int Wound J 2024;21:e70093.
Pérez-Sánchez S, Madueño SE, Montaner J. Gender gap in the leadership of health institutions: the influence of hospital-level factors. Health Equity 2021;5:521-5.
Franco PL, Christie LM. Effectiveness of a one day self-compassion training for pediatric nurses’ resilience. J Pediatr Nurs 2021;61:109-14.
Biresaw H, Asfaw N, Zewdu F. Knowledge and attitude of nurses towards patient safety and its associated factors. Int. J Afr Nurs Sci 2020;13:100229.
Hu L, Sae-Sia W, Kitrungrote L. Intensive care nurses’ knowledge, attitude, and practice of pressure injury prevention in China: a cross-sectional study. Risk manag healthc policy 2021:4257-67
Refbacks
- There are currently no refbacks.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.