Knowledge and attitudes toward pressure injury prevention among nursing professionals – A cross-sectional study at six German university hospitals

Pressure injuries pose a significant healthcare challenge, with prevention relying on nursing knowledge and attitudes. This study evaluated German nurses’ knowledge of pressure injury development, prevention, and classification, as well as their attitudes, continuing education (CE) participation, and self-perceived training needs. As the first large-scale assessment in Germany, it aimed to identify knowledge gaps and associated factors in acute inpatient care. A cross-sectional study was conducted at six German university hospitals using an online questionnaire. Participants were nurses with at least 3 years of vocational training. Knowledge was assessed using the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0), and attitudes with the Attitude towards Pressure Ulcer Prevention (APuP) instrument. Data on completed and needed CE were collected. Statistical analyses included descriptive and inferential methods, including bivariate and multiple linear regression. The online questionnaire was accessed 1286 times. Participants who completed the PUKAT 2.0 instrument (n = 688) scored a median of 60% (IQR: 52–68) correct answers. However, prevention knowledge was lower (median: 38%). Attitudes were positive with a median APuP-Score of 36, (IQR: 34–38; n = 714). Of the 646 participants who fully answered the questions about CE 60% had attended recent CE, and 90% reported a need for further training, especially in risk assessment and prevention. A statistically significant but clinically irrelevant association between knowledge and attitude could be observed (β = 0.007; p < 0.001). This study reveals strengths and gaps in German nurses’ pressure injury knowledge. Although knowledge exceeds international results, prevention deficits remain. Targeted education could improve prevention. Future research should address contextual barriers to reduce pressure injury incidence.