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Nurses’ adherence, barriers, and facilitators to evidence-based pressure injury prevention practice in pediatric critical care units: A cross-sectional study

Year: 2026

Type: article

Abstract: To explore nurses’ adherence and influencing factors to pressure injury (PI) prevention based on guidelines, and identify perceived barriers and facilitators to the evidence-based PI prevention practice in pediatric critical care units. A multi-site, quantitative, cross-sectional study spanning 16 provinces in China was conducted. Data were collected by a self-reported questionnaire, including three sections: demographic information, adherence to evidence-based PI prevention, and barriers to and facilitators of PI prevention practice. The data were analyzed using SPSS 27.0. In total, 574 nurses finished the online survey. The mean score of the evidence-based PI prevention compliance was 133.50 ± 15.10 (total score = 30-150), with a scoring rate of 89%. 54.9% of pediatric critical care nurses reported good adherence to PI prevention practice based on the guideline. The highest and lowest adherence mean score was observed in the “skin assessment and care” subscale (41.56±4.44, 92.36%) and “pressure injury risk assessment” (24.75 ± 5.10, 82.5%). Undergoing PI guideline training ( β = 0.096, P =0.039), smaller ward size (β = -0.127, P = 0.013), and hospital in eastern China ( β = 0.14, P = 0.042) were significantly associated with higher adherence. Low cooperation from patients and leadership support were identified as the top barriers and facilitators to the nurses’ adherence in practicing PI prevention. The adherence of nurses in pediatric critical units was relatively desirable. PI prevention adherence was influenced by several factors. There are some special barriers related to PI prevention adherence identified in pediatric critical care nurses. The findings may inform a theory and intervention to help the PI intervention in pediatric patients in critical care units. • Pediatric critical care nurses showed a high overall adherence rate (89%) to evidence-based pressure injury prevention. • Adherence was significantly higher among nurses who had received specific pressure injury guideline training and those working in smaller ward settings and hospitals in eastern China. • A major perceived barrier to prevention practices was low cooperation from pediatric patients, a challenge uniquely salient in the child and infant population. • Strong leadership and institutional support were identified as the top facilitators, suggesting that organizational culture is crucial for implementing evidence-based pressure injury prevention.

Source: Journal of Tissue Viability

DOI: 10.1016/j.jtv.2026.100989