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Determinants of practices among nurses regarding pressure injury prevention: a cross-sectional study in Saudi Arabia

Year: 2026

Type: article

Abstract: Despite the fact that pressure injuries continue to be a key measure of both the quality of nursing care and the safety of patients, there is limited research into the factors which determine how often nurses take part in pressure injury prevention activities, especially in areas where staffing varies and the acuity levels of patients vary. The purpose of this study was to evaluate the extent to which nurses engage in the practice of preventing pressure injuries, and to identify factors such as demographics, professional characteristics, and organizational structure related to this activity. A cross-sectional survey was completed with 185 nurses from various clinical units across multiple hospitals in Saudi Arabia. Practice regarding pressure injury prevention was measured utilizing a previously validated instrument consisting of nine items. Data collection and analysis included descriptive statistics, independent t-test, one-way ANOVA, and multiple linear regression. Data collection was conducted between October 1 and November 1, 2025. Nurses reported practicing preventive measures for pressure injuries at a rate of 85.3%, as indicated by an average practice score of 23.02 ± 4.48 out of 27. Univariate analyses demonstrated statistically significant differences in practice based upon nationality ( p = .005), educational attainment ( p = .008), number of years of experience ( p = .032), and nurse-to-patient ratio ( p < .001). Nurse-to-patient ratio emerged as the strongest independent predictor of pressure injury prevention practice scores. Specifically, nurses who had a nurse-to-patient ratio of 1:8 scored approximately 2.17 points fewer on a measure of preventive practices than did nurses with a nurse-to-patient ratio of 1:4 (B = − 2.165, 95% CI [–3.776 − 0.554] p = .008). Given the number of predictors relative to sample size, these findings should be interpreted with caution and require replication in larger samples. Results indicate that the nurse-to-patient ratio impacts the ability of nurses to prevent pressure injuries. Excessive workloads due to high numbers of patients may create structural barriers to completing essential patient care tasks such as skin assessments and turning. Overall, although compliance appears excellent; there is evidence that nurses working at higher ratios perform fewer preventative actions for each patient than do their colleagues who have lower nurse-to-patient ratios. While education/experience can never overcome system-wide over loading, healthcare executives and public policy makers should make establishing 1:4 ratios as the least number of staff needed for safe staffing practices. Not applicable.

Source: BMC Nursing

DOI: 10.1186/s12912-026-05280-w