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Effect of Pressure Injury Prevention Education on Pressure Injury Prevention Practices among Nurses in Nigeria

Abstract

Pressure injuries are an important patient safety and nursing care concern, particularly among hospitalized patients with limited mobility, prolonged bed rest, impaired sensation, poor nutritional status, or serious underlying illnesses. If not prevented and managed appropriately, pressure injuries can cause pain, infection, prolonged hospitalization, increased healthcare costs, delayed recovery, and reduced quality of life. Nurses play a central role in pressure injury prevention because they are directly involved in patient assessment, repositioning, skin care, nutrition-related monitoring, mobility support, and implementation of preventive interventions. Pressure injury prevention education provides nurses with knowledge and practical skills relating to pressure injury risk factors, early identification of patients at risk, skin assessment, pressure redistribution, repositioning, appropriate support surfaces, moisture management, nutritional considerations, mobility assistance, documentation, and regular monitoring. Pressure injury prevention practices refer to the actions undertaken by nurses to reduce patients' risk of developing pressure injuries, including risk assessment, regular repositioning, skin inspection, pressure redistribution, moisture management, appropriate use of support surfaces, nutritional monitoring, mobility assistance, and documentation of preventive care. In Nigeria, inadequate pressure injury prevention education, limited availability of appropriate support surfaces and preventive equipment, high nursing workloads, staff shortages, inadequate nutritional support, and inconsistent implementation of pressure injury prevention protocols may affect nursing practices in hospitals. Effective pressure injury prevention education may improve nurses' knowledge, confidence, clinical decision-making, and adherence to recommended preventive measures. Against this background, this study investigates the effect of pressure injury prevention education on pressure injury prevention practices among nurses in Nigeria. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and Experiential Learning Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping nurses' clinical practices. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from pressure injury prevention education may influence preventive nursing practices. Experiential Learning Theory emphasizes learning through practical experience, demonstration, practice, reflection, and application, making it particularly relevant to skills-based pressure injury prevention education. Collectively, these theoretical perspectives provide a suitable framework for explaining how pressure injury prevention education may influence pressure injury prevention practices among nurses in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from nurses providing care to hospitalized patients in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, pressure injury prevention knowledge assessment, and an observational pressure injury prevention practices checklist. A multistage sampling technique will be employed to select states, local government areas, hospitals, clinical departments, and eligible nurses. Where feasible, selected hospitals or nurse groups will be assigned to intervention and comparison groups. Nurses in the intervention group will receive structured pressure injury prevention education covering pressure injury risk factors, patient risk assessment, skin inspection, repositioning techniques, pressure redistribution, appropriate support surfaces, moisture management, mobility assistance, nutritional considerations, documentation, and regular monitoring. Pressure injury prevention practices will be assessed using indicators such as pressure injury risk assessment, routine skin inspection, appropriate repositioning, use of pressure-redistribution measures, moisture and incontinence management, appropriate use of support surfaces, mobility assistance, nutritional monitoring, and documentation of preventive interventions. Direct observation and review of relevant nursing records will be prioritized where feasible to reduce reliance on self-reported practices. Descriptive statistics will be used to summarize nurses' sociodemographic and professional characteristics, previous pressure injury training, pressure injury prevention knowledge, exposure to education, and prevention practice scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of pressure injury prevention education on pressure injury prevention practices. Where appropriate, pre-intervention and post-intervention practice scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that pressure injury prevention education has a significant positive effect on pressure injury prevention practices among nurses in Nigeria. Nurses exposed to structured pressure injury prevention education are expected to demonstrate greater adherence to recommended preventive procedures, including pressure injury risk assessment, skin inspection, repositioning, pressure redistribution, moisture management, appropriate use of support surfaces, mobility assistance, nutritional monitoring, and documentation. Education may also improve nurses' ability to identify patients at increased risk and initiate appropriate preventive interventions before skin damage occurs. Practical and demonstration-based education may further improve nurses' confidence and ability to apply pressure injury prevention principles during routine patient care. However, education alone may not guarantee sustained preventive practices because nurses may continue to face barriers such as inadequate staffing, high workloads, limited availability of pressure-redistribution equipment, insufficient support surfaces, inadequate nutritional resources, and weak institutional monitoring. Consequently, pressure injury prevention education is expected to be most effective when supported by adequate staffing, appropriate preventive equipment, standardized clinical protocols, regular supervision, routine risk assessment, multidisciplinary collaboration, and continuous professional development. The study is expected to contribute to the literature on pressure injury prevention, nursing practice, patient safety, healthcare worker education, quality of care, clinical nursing, hospital management, and public health in Nigeria by providing empirical evidence on the effect of pressure injury prevention education on pressure injury prevention practices among nurses. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospital management authorities, Nursing and Midwifery Council of Nigeria, nursing training institutions, professional nursing associations, hospital quality improvement committees, healthcare administrators, development partners, and policymakers regarding strategies for reducing preventable pressure injuries in Nigerian hospitals. The study will also provide evidence-based recommendations for integrating pressure injury prevention education into nursing education and continuing professional development, strengthening routine pressure injury risk assessment, improving availability of preventive equipment and support surfaces, enhancing nursing documentation and monitoring, strengthening supportive supervision, and promoting consistent evidence-based pressure injury prevention practices among nurses in Nigeria.

Keywords: Pressure injury prevention education, pressure injury prevention practices, nurses, Nigeria, pressure injuries, patient safety, nursing practice, pressure injury risk assessment, skin care, repositioning, pressure redistribution, healthcare worker education, quality of care, hospital care, public health.