Mismatch between global patient blood management policy and nursing education: evidence from four countries

Patient Blood Management (PBM) is an evidence-based approach to optimising transfusion practices and improving patient outcomes, yet its integration into nursing education remains limited and insufficiently explored across healthcare systems. This study examined nursing master's students' awareness, knowledge, attitudes, and educational needs related to PBM and non-blood management in a cross-national context.

A cross-sectional web-based survey was conducted among 645 nursing master's students from Poland, Germany, Kazakhstan, and Iran between October 2023 and April 2024. A purpose-built questionnaire assessed self-reported awareness and objective knowledge across PBM domains. Knowledge indices were analysed using Poisson regression to identify associations with socio-demographic and professional factors.

Students across all countries demonstrated consistently low objective knowledge despite moderate self-reported awareness, indicating a clear awareness-knowledge gap. Mean scores for self-reported knowledge ranged from 1.40 to 2.03, whereas mean objective knowledge scores ranged from 2.83 to 6.86 for non-blood management techniques, 1.91 to 5.53 for pharmacological PBM strategies, and 1.22 to 4.28 for PBM-related risks. Deficits were evident across key PBM domains, including alternative treatments, pharmacological strategies, and associated risks. Although some between-country variation was observed, overall patterns remained consistent. Higher knowledge levels were associated with greater professional experience, prior exposure to patients refusing transfusion, and selected socio-demographic factors. Most participants reported insufficient formal PBM education, with only a minority feeling adequately prepared, alongside a strong demand for structured training.

PBM remains insufficiently embedded in nursing education, which may limit preparedness for safe and evidence-based transfusion practice. Strengthening its integration into curricula and postgraduate training may help bridge the gap between global PBM recommendations and clinical competence.