Effect of an educational intervention on nurses' knowledge, attitudes, and practices in adherence to pressure injury...

Pressure injuries are a significant preventable cause of patient injury, and nurses' adherence to evidence-based preventive strategies is essential. Systematic education could enhance knowledge, attitudes, and preventive actions beyond conventional in-service training. This study aimed to determine the effect of an educational intervention on nurses' knowledge, attitudes, and practices related to adherence to pressure injury prevention guidelines compared with routine education.

A parallel-group, randomized controlled trial was conducted between January 1 and March 5, 2026 in a tertiary hospital in Riyadh, Saudi Arabia, including 222 registered nurses (n = 111 each for intervention and control) recruited from high-acuity and general inpatient settings. The intervention comprised structured education delivered through didactic lectures, interactive discussions, case-based learning, and practical demonstrations, supplemented with printed handouts and reinforcement reminders. The assessments were conducted using validated knowledge, attitudes, practice, and adherence measurement instruments. Independent samples t-tests were used for initial comparisons.

The baseline characteristics and pre-intervention scores were comparable between the groups. Post intervention, the structured education group demonstrated significantly higher knowledge (t(220) = - 36.08, p < .001), attitude (t(220) = - 50.62, p < .001), practice (t(220) = - 28.43, p < .001), and adherence scores (t(220) = - 42.86, p < .001) than the routine group. An analysis of covariance confirmed significant group effects after adjusting for baseline values, with large effect sizes were observed across outcomes, with Cohen's d ranging from 3.80 to 6.80, for knowledge (η² =0.905), attitude (η² =0.938), practice (η² =0.800), and adherence (η² =0.932). Regression analysis showed that post-intervention knowledge, attitude, and practice explained 83.6% of the variance in adherence (R² =0.836), with attitude emerging as the strongest predictor (β = 0.470, p < .001).

Structured education produced substantial improvements in nurses' knowledge, attitudes, practice, and adherence in relation to PIP protocols. Attitudinal change plays a pivotal role in enhancing adherence. Integrating structured, competency-based educational programs into routine professional development may strengthen patient safety and reduce preventable PIs.

This randomized controlled trial was registered early in the study period and before participant enrollment in the Clinical Trials Registry (ISRCTN14515418) on January 5, 2026.