Exploring nurses’ knowledge on pressure injury prevention in a Maltese long-term care facility

Abstract

Background: Pressure injuries (PIs) pose a significant challenge in long-term care (LTC) facilities, where elderly residents are particularly vulnerable due to immobility, comorbidities, and age-related skin changes. Nurses are central to PI prevention efforts; however, knowledge deficits and systemic barriers can hinder effective care. While some international studies and one Maltese study have examined nurses' knowledge of pressure injuries, limited attention has been given specifically to pressure injury prevention knowledge among nurses working in long-term care (LTC) facilities in Malta. Objective: This study aimed to assess the level of knowledge that nurses in a Maltese LTC facility possess regarding PI prevention and to explore the perceived barriers that hinder their ability to implement best practices. It further examined how socio-demographic variables such as age, educational level, and clinical experience influence knowledge levels. Design and Methods: A descriptive, cross-sectional quantitative study was conducted among nurses working across various wards within a large LTC facility in Malta. A total of 283 nurses participated (response rate: 58.95%) out of 480 eligible staff. Data were collected using a structured, paper-based questionnaire comprising three sections: demographics, knowledge assessment using the Pressure Ulcer Knowledge Assessment Tool (PUKAT), and a checklist of perceived barriers. Non-parametric tests and correlation analyses were employed due to non-normal data distribution. Population: The study focused on nurses across a wide range of ward environments within a Maltese LTC facility, including those working in dementia care units, high-dependency wards, and chronic care sections. Both full-time and part-time nurses were included, encompassing various nursing ranks such as enrolled nurses, staff nurses, senior nurses, and charge nurses. Only departments with limited relevance to pressure injuries, such as outpatient clinics and training areas were excluded. Results: The findings indicated that nurses demonstrated a generally moderate but insufficient level of knowledge regarding PI prevention. While most nurses were familiar with basic risk factors, many struggled with more complex concepts such as shear forces, staging of injuries, and repositioning protocols. Knowledge was notably stronger in areas relating to support surfaces but weaker in risk assessment and the physiological causes of PIs. Nurses with formal education in PI prevention, those who engaged in ongoing professional development, and those with greater clinical experience tended to exhibit better understanding. Several systemic and institutional barriers were reported as hindrances to effective prevention these included staffing shortages, excessive workload, and limited access to pressure-relieving devices and up-to-date training resources. Although no direct link was found between overall knowledge and the total number of perceived barriers, nurses with stronger knowledge were less likely to perceive certain barriers as major. Conclusion: The findings underscore the need for structured, ongoing education and professional development in PI prevention within LTC settings. Addressing systemic barriers and investing in evidence-based training programs are essential for improving nurses’ competencies and patient outcomes. Institutional policies should also focus on resource allocation and mentorship to promote best practices in wound care and prevention.