Nurses' attitude on pressure injury prevention: A systematic review and meta-analysis based on the pressure ulcer prevention instrument (APuP)

Background: Prevention of pressure ulcers (PU) is one of the most important indicators of the quality of patient care that may be influenced by the attitude of nurses. Nurses are responsible for maintaining the integrity of the skin and preventing its complications. The aim of this study was to assess the overall attitude of nurses on PU prevention based on their scores on the Attitude towards Pressure ulcer Prevention instrument (APuP). Methods: In this systematic review and meta-analysis, databases including Web of Science, Science Direct, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, Attitude, and their possible combinations. Heterogeneity of studies was assessed with I2 index and Cochrane-Q test. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All the analyses were performed using STATA v.16 software. Results: Twelve studies with a sample size of 7824 people were analyzed. The overall score of attitude towards pressure ulcer prevention was 70.84% (95% CI: 66.34-75.35) and the highest and lowest scores were related to the dimensions of individual priority (78.83%, 95% CI: 74.69-82.97) and competence (70.11%, 95% CI: 67.24-72.94), respectively. The percentage of the total score of attitude towards pressure ulcer prevention in nurses was higher than nursing students (72.15%, 95% CI: 67.10-77.20 vs. 67%, 95% CI: 53.80-80.20). Sensitivity analysis confirmed the stability of the results. Publication bias was significant (p = 0.036). Conclusion: The attitude of nurses and nursing students towards the prevention of pressure ulcers was moderate, and providing the necessary training to these groups was essential.