Impact of multifaceted interventions on pressure injury prevention: a systematic review

The study was conducted by a diverse group of authors, including Bassam Alshahrani [15] Ebtsam Saad Soliman [16], Esraa Mohammedalhussin Abdelhalim [17], Lei Ding [18], Heba Mohamed Tawfik [19], Na, Hyung-Ju [20], Talal ALFadhalah [21], AAbiru Neme [22], Mohammad Y. N. Saleh [23], Gulay Yazıcı [24], Samia Gaballah [25], Tuba Sengul [26], Habtamu Bekele [27], Zhenyu Luo [28], Despina Georgieva [29], Pramila Baral [30], Ruth Alexandra Castiblanco-Montanez [31], Kawther Badry Mobed [32], Fatma Mohamed Elesawy [33], Gehan Abd Elfattah Atia Elasrag [34], Mona Mohamed Ibrahim [35], Hanaa E. Elsayad [36], Mona Mohamed Mayhob [37], Doaa Mohamed Mahmoud [38], Manal Tharwat AbouZaid [39], E.S.S.Saad [40], Rekha Pant [41], Fitri Anita [42], Shenda Maulina Wulandari [43], Masoud Hatefi [44], Fatma Magdi Ibrahim [45], Amany Elberdan [46], Lindsey Stevens [47], Busra İpek [48], Asmaa Nasr ELdin Mosbeh [49], Vanessa Leal de Lima de Moura [50], Edward, M.I [51], Esraa Mohammedalhussin [52].

The study was conducted across multiple years, spanning from 2020 to 2024. This timeframe reflects the recent nature of the research and allows for the inclusion of up-to-date findings and developments in pressure injury prevention and nursing practices. Specifically, the study included data and findings from the years 2024 [15, 21, 27, 47], 2023 [10, 13, 18, 25, 30, 33, 37], 2022 (35, 16, 21, 6, 31, 20, 15, 8, 2, 9, 15, 25, 13, 4, 5), 2021 (20, 7, 33, 28, 37, 10), 2020 [3, 24, 27, 29, 30]. By incorporating research conducted over several years, the study aims to capture the evolution and effectiveness of interventions and practices in addressing PI within healthcare settings.

The study encompassed a diverse range of countries, reflecting the global significance of pressure injury prevention and nursing practices. These countries include Australia-1 [15], Kuwait-1 [21], Ethiopia-2 [3, 18], New York, United States-1 [47], Jordan-1 [23], Saudi Arabia-1 [52], Egypt-14 [2, 4, 5, 8, 9, 14, 16, 19‐21], India-1 [41], Turkey-3 [6, 17, 36], China-1 [18], Iran-1 [44], UAE-1 [33], Brazil1 [50], Nigeria-1 [51]. The inclusion of such a varied set of countries allows for a comprehensive examination of pressure injury prevention strategies and nursing practices across different healthcare systems, cultural contexts, and resource settings. By considering the experiences and approaches of multiple countries, the study aims to provide insights that are applicable and relevant to a broad spectrum of healthcare settings worldwide.

The study was conducted across a diverse range of healthcare settings, reflecting the breadth and depth of research on pressure injury prevention and nursing practices. These settings include Critical care units in 3 hospitals [15], Public general hospitals, 54 medical wards [21], Specialized hospitals in the Northwest Amhara Region [27], Neurosurgery stepdown unit in a large teaching hospital [47], Three Jordanian medical settings [23], King Fahad Hospital [52], South Valley University Hospital [33], Orthopaedic department at Menoufia University Hospital [36], Teer thanker Mahaveer University Hospital of Moradabad [41],Private hospital administered by a foundation in Istanbul [26], State university hospital in Ankara [24], Four medical centres in China [18], Trauma and emergency department at Assiut University Hospital [32], Intensive care units (ICU) at Menoufia University Hospital [34], Benha University Hospital’s orthopaedic unit [38], Mansoura University and emergency hospitals [16], Orthopaedic department of Benha University Hospital [40], ICU of the General Mansoura Hospital, Specialized Medical Hospital, and Emergency Hospital in Dakhalia governorate [45], ICU [46], Neonatal Intensive Care Unit (NICUs) at El-Fayoum University Hospital and El-Fayoum Public Hospital [49], Ain Shams University Hospitals and in Suez Canal University Hospitals [19], General hospitals, in Ismailia City [25], 8 orthopedic departments of one of the governmental hospitals in Egypt [35], University of Medical Sciences Teaching Hospital(UMSTH), Akure and UMSTH, Ondo [51], Nepal Medical College Teaching Hospital [30], Medium-sized hospital, located in Seoul [20], Public hospitals [22], Neurological units (A and B) at Mansoura University Hospital, and emergency hospitals (35, 39).

The study duration varied across the included research, spanning from specific date ranges to broader periods. These durations include May 2021 and April 2022 [15], December 2021 to March 2022 [21], June 15 to June 19, 2022 [27], January to March 2022 [47], 2019 to 2021 [17], 1 July 2022 and ends on 1 August 2022 [28], August 1 and December 31, 2021 [26], 17–23 December, 2018 [24], January 2014 to December 2018 [18], May and November 2019 [29], November-2020 [50], August 2019 to January 2020 [30], December 18, 2017 to February 28, 2018 [20], March13-April 12, 2017 [22].These varied durations reflect the different timelines of data collection, intervention implementation, and study periods across the included research studies.

The study designs encompass a wide range of methodologies, reflecting the diverse approaches used in research on pressure injury prevention Multiple Components on One System (MCOS) (Prepost intervention study) [15], CSRD examining pressure injury prevalence and nursing practices across different healthcare settings [21], Institution-based, cross-sectional study focusing on specific institutions [3, 18], Prospective, quasi-experimental, single-group designs for evaluating interventions’ effectiveness [47], Prospective approach [23], Regression-Based Historical Benchmarking System (RHBS) for analysing historical data [52], Description of Observed Situations (DOS) for documenting practices without interventions [28], Quasi-experimental design [4, 13, 14, 19, 21, 28], Correlative descriptive method with a cross-sectional approach [43], Cross-sectional and descriptive study [25, 30, 32, 36], Descriptive study [5, 17], Mixed case-control studies for comparing individuals with and without Pressure Injuries [18], Cross-sectional, descriptive, prospective design [48], Experimental research design [34], Quasi-experimental research approach (study and control groups) [8, 33], Quasi-experimental, pre-test, and post-test intervention study design [2, 15, 27], Case-control study [19], Cross-sectional descriptive non-experimental design [51] are employed to assess interventions’ impacts. These varied study designs offer complementary insights into pressure injury prevention and nursing practices, contributing to a comprehensive understanding of the field.

The sample sizes varied across the studies, reflecting the diversity of research approaches and objectives in pressure injury prevention and nursing practices. These included samples of 181 patients [15], 1,186 patients [21], 480 patients [27], Participants were 329 adult patients [23], Hospitalized patients [17], Thirty-six nurses and eighty patients were recruited [33], Consecutive sample of 118 immobilized adult patients of both genders [36], Corona virus Disease 2019 (COVID19) patients [26], Patients [17, 22], 50 medical records [31], 33 male and 27 female [32], Control and study group 50 patients [34], sixty adult patients [38], 50 nurses, 80 patients [2, 9], 17 patients for each group (intervention and control) [42], Elderly male and female patients [19], 120 hospitalized patients [29], Thirty nurses and fifty patients [25], 80 (40 patients in each intervention and control groups) [35], 272 patients [30], Patients [20], Hospitalized patients [22], 40 nurses [35], Nurses and patients [39]. The inclusion of different sample sizes and participant groups allows for a comprehensive exploration of pressure injury prevention strategies and nursing practices across diverse populations and settings.

The study sample sizes varied significantly, ranging from smaller cohorts to larger populations. These included samples of 181 patients [15], 1,186 patients [21], 480 patients [27], 35 Nurses [47], 329 adult patients [23], 21,400 admitted patients [17], 6 Pressure injury specialist nurses [28], 80 staff nurses [41], 46 respondents [43], 345 patients [26], 23 patients [24], 1977 patients [18], Hospitalized. Patients [31], 60 patients [32], 220 Sample size [44], 69 nurses [45], 51 nurses and 80 patients [46], 80 nurses [49], 100 patients [19], 120 hospitalized patients [29], 30 nurses and 50 patients [25], 80 (40 patients in each intervention and control group) [35], 27 nurses [50], 272 patients [30], 100 patients [20], 356 subjects [22], 55 nurses, 207 patients [39]. The diversity in sample sizes reflects the scope and objectives of the research, accommodating investigations across various healthcare settings and populations.

The sampling techniques employed in the studies varied, reflecting different approaches to participant selection and recruitment. These included a systematic random sampling technique [27], Convenience sample(22, 27, 40, 15, 45, 48, 34), Total sampling technique [43], Purposive sampling method [18, 33, 34, 37, 47], Random sampling technique [20], Multistage sampling technique [22].The diversity in sampling techniques reflects the researchers’ considerations of feasibility, accessibility, and study objectives in pressure injury prevention and nursing practices.

The instruments used in the studies varied, encompassing a range of tools and scales related to pressure injury prevention and assessment. These included Braden scores/Braden Risk Assessment Scale (BRAS) [14, 17, 20‐23, 25, 28, 30, 46, 49], includes; Sensory perception, moisture, activity, friction /shear, mobility, and Nutritional Blood Sugar (nut BS) used for Predicting Pressure Sore Risk [17], Medical Device-Related Pressure Injury (MDRPI) and Braden score sessions [28], Structured interview questionnaire; nurses’ pressure ulcer preventive practices observational checklist, comprehensive skin assessment tool, and Braden score [33], Instrument I: Structured Interview questionnaire, Instrument II: Comprehensive skin assessment observation checklist, Instrument III: BRAS [36], Braden Q scale (Q stands for “Quick” or “Quality”), Nurses knowledge assessment tool [43], Sociodemographic and Clinical Characteristics Form and 3 S intraoperative risk assessment scale (3 S-IRAS) for Pressure Injury and Braden score [48], Skin assessment observation check list and Braden score [32], 1st tool: Predesigned questionnaire which contained two parts, 2nd tool: Braden score and 3rd tool: European Pressure Ulcer Advisory Panel (EPUAP) and 4th tool: The Pressure Ulcer Scale for Healing (PUSH) [34], Comprehensive skin assessment sheet, BRAS [38], Interview questionnaire, Observational check list for nurses’ practice, Braden score, Patient’s assessment questionnaire [16], Interview Questionnaire, II Observational check list for nurses’ practice, III Braden score & Inpatient’s’ Assessment questionnaire [40], Assessment of the risk of Pressure injury using the Braden score, and monitoring of changes in position using the observation sheet [42], Demographic profile form and the Braden score for Predicting pressure ulcer Risks [44], Braden score and a two-part structured interview schedule sheet [45], Structured interview sheet, observational checklist, Braden score [46], Predesigned Questionnaire format to assess characteristics of the studied nurses and their knowledge regarding skin care and Braden Q Scale [49], Checklist and Braden score [19], Nurse ’s demographic data sheet, Pressure injury knowledge questionnaire, Pressure injury care observational checklist, Patient’s demographic and medical profile data sheet, The Braden score, and Patients’ Pressure injury wound healing outcomes tool [25], Patient assessment tool, BRAS [35], Braden score in predicting Pressure injury risk, questionnaire [51], Brief Symptom Rating Scale (BSRS) and the 6stage pressure ulcer classification system [20], Interview Questionnaire Sheet, The Pieper Zulkowski-Pressure Ulcer Knowledge Test (PZPUKT), Facility Assessment Checklist, Moore & Price attitude scale, Socio-demographic and medical clinical base line data for patients and Braden score [35], A structured interview, wound care observational checklist, Braden score, wound assessment tool [39]. The diversity in instruments reflects the comprehensive approach adopted by researchers to assess Pressure injury risk, preventive practices, and patient outcomes.

The results of the studies highlighted various aspects related to Pressure injury prevalence, nursing practices, risk factors, and the effectiveness of interventions. Pressure injury prevalence was observed to decrease significantly post-intervention, with HAIs decreasing from 52.9 to 21.3%. The mean national prevalence of Pressure Injuries was reported as 17.6%, with a majority of injuries being community-acquired. Specific prevalence rates ranged from 10.2 to 60.9%, depending on the study population and setting. Educational interventions were found to improve nurses’ comprehension and practices, leading to a reduction in hospital-acquired pressure ulcers. The prevalence of medical device-related Pressure injury was reported as 5.01%. Risk factors such as age, sex, Braden rating, and diabetes were identified as independent predictors of Pressure injury. Additionally, the effectiveness of skin integrity care bundles and wound care protocols in preventing pressure ulcers was highlighted, with positive outcomes observed among the study groups. Overall, the results underscored the importance of educational interventions, evidencebased practices, and comprehensive care protocols in mitigating Pressure injury risks and improving patient outcomes (Table 2).

According to a study conducted by Bassam Alshahrani and colleagues in 2024, the initial prevalence of Pressure injury was alarmingly high at 60.9%. This included 52.9% of cases being hospitalacquired, 37.9% originating within specific units, and 23.0% linked to medical devices. However, a significant reduction in these numbers was observed post-intervention. The overall prevalence dropped to 28.7%, with hospital-acquired cases decreasing to 21.3%, unit-acquired cases to 14.9%, and medical device-related cases to 8.5% [15].

In a revealing study by Talal ALFadhalah et al. (2024), the national prevalence of PI was found to be 17.6% on average (95% CI: 11.3–23.8). Surprisingly, the majority of these cases, 58.1%, were community-acquired, emphasizing the need for increased focus on preventative measures and education outside of hospital settings [21].

In a detailed study by Habtamu Bekele et al. (2024), pressure ulcers were identified in 49 out of 480 patients, resulting in a prevalence rate of 10.2% (95% CI: 7.7–12.9). This finding highlights a significant concern in patient care, where approximately one in ten patients was affected by this condition, emphasizing the ongoing need for effective prevention and management strategies [27].

In an insightful study by Lindsey Stevens et al. (2024), nurses exhibited a marked improvement in comprehension following an educational intervention. The data revealed a significant increase in understanding from the initial assessment (T1) to the third evaluation point (T3), underscoring the effectiveness of the training program in enhancing nursing knowledge and skills [47].

In an illuminating study by Mohammad Y. N. Saleh et al. (2023), the prevalence of MDRPI was found to be 5.01%, with 15 out of 299 patients affected. Among the 41 documented injuries, a significant 65.8% (27 injuries) were skin-related, while 34.2% (14 injuries) impacted mucosal tissues. This data highlights the diverse nature of MDRPI and the critical need for targeted prevention strategies [23].

In a compelling study by Esraa Mohammedal hussin Abdelhalim et al. (2023), a remarkable decline in HAPUs was observed over a four-year period. The prevalence decreased from 1.97% in 2018 to 1.4% in 2019, and continued to plummet to 0.53% in 2020, ultimately reaching an impressive low of 0.14% in 2021. This significant downward trend underscores the effectiveness of enhanced preventive measures and quality care initiatives in hospitals [17].

In a study conducted by Zhenyu Luo et al. (2023), fascinating insights were revealed about patient conditions and referral times. On average, participants were referred within 2.26 ± 0.26 h. The mean Braden score among participants stood at 15.32 ± 2.06, indicating a moderate risk of pressure ulcers. Additionally, 53.46% (n = 54) of the participants were conscious, with a majority of 73.26% (n = 74) positioned supine. Meanwhile, 23.76% (n = 24) were in a semi-recumbent position, and a mere 2.9% (n = 3) were in the lateral position. These findings provide valuable data for optimizing patient care strategies and positioning protocols [28].

In a transformative study by Fatma Mohamed Elesawy et al. (2023), the implementation of a targeted educational program led to a substantial enhancement in nurses’ knowledge and practices regarding pressure ulcer prevention. The program’s impact was profound, significantly boosting the competence and proactive measures of nursing staff in mitigating the risk of pressure ulcers. This highlights the pivotal role of continuous education in elevating healthcare standards and patient outcomes [33].

In a captivating study by Hanaa E. Elsayad et al. (2023), intriguing demographic patterns emerged. Within the study group, 49.2% fell within the age bracket of 50 to 60 years, while 35.6% of the control group shared this age range. Notably, gender distribution revealed a near balance, with approximately half of both the study (50.8%) and control (54.2%) groups comprising males. These findings shed light on the diverse demographic landscape under study, offering valuable insights into potential correlations with health outcomes [36].

In a comprehensive investigation spearheaded by Rekha Pant et al. (2023), a detailed examination of staff nurses’ knowledge and attitudes unveiled a nuanced picture. Among the 80 sampled staff nurses, 49 (61.2%) were identified as having inadequate knowledge, while 25 (31.3%) exhibited moderate knowledge levels. Surprisingly, only 6 (7.5%) nurses possessed adequate knowledge. Furthermore, in terms of attitudes, the majority of respondents, comprising 53 (66.3%) individuals, harboured unfavourable perspectives, while a noteworthy minority of 27 (33.7%) nurses held favourable attitudes. These findings emphasize the imperative for tailored educational initiatives aimed at bolstering both knowledge acquisition and attitude transformation within nursing staff, thus fostering enhanced patient care practices [41].

In a captivating study led by Shenda Maulina Wulandari et al. (2023), intriguing findings emerged regarding nurses’ proficiency with the Braden Q scale. The research unveiled a heartening revelation: more than half of the nurses exhibited a commendable level of knowledge concerning this scale. This highlights a promising trend in healthcare education, suggesting a strong foundation among nursing professionals in assessing and managing patients’ risk for pressure ulcers using the Braden Q scale [43].

In a pioneering study led by Tuba Sengul et al. (2022), an insightful analysis of the Braden score total scores among patients yielded compelling results. Among those with Pressure injury, the mean score stood at 16.50 ± 3.83, reflecting a moderate risk level. Conversely, for patients without Pressure injury, the mean score was notably higher at 20.05 ± 3.07, indicating a lower risk profile. This nuanced comparison underscores the critical role of risk assessment tools like the Braden score in identifying and mitigating the occurrence of Pressure injury among patients, thereby facilitating proactive healthcare interventions [26].

In a groundbreaking study led by Gulay Yazıcı et al. (2022), an insightful exploration into the prevalence and characteristics of Pressure injury among patients revealed compelling findings. Within the scope of this research, Pressure injury were detected in 17.4% of the patients under observation. Strikingly, a substantial majority (85.71%) of these injuries were acquired within the hospital setting, highlighting the critical need for preventive measures within healthcare facilities. Among the detected Pressure Injuries, 57.14% were categorized as stage 1, emphasizing the importance of early detection and intervention. Furthermore, a significant portion (71.4%) of these injuries were attributed to medical devices, shedding light on a potential area for targeted intervention and improvement in patient care practices. These findings underscore the multifaceted nature of PI and the importance of comprehensive strategies to mitigate their occurrence and impact on patient well-being [24].

In an illuminating study conducted by Lei Ding et al. (2022), independent risk factors for Community-Acquired Pressure Injuries (CAPI) were unveiled, shedding light on key contributors to this prevalent healthcare concern. Age emerged as a significant factor, with each year increment correlating with a 3.1% increase in CAPI risk. Conversely, gender exhibited a protective effect, with females showing a decreased risk (OR = 0.810). The Braden rating, a widely used risk assessment tool, demonstrated its predictive power, with higher scores associated with elevated CAPI risk (OR = 1.235). Notably, diabetes emerged as a substantial independent risk factor, more than doubling the odds of CAPI occurrence (OR = 2.059). These insights underscore the multifaceted nature of CAPI and emphasize the importance of tailored preventive strategies addressing demographic factors and underlying health conditions [18].

In a groundbreaking study led by Busra İpek et al. (2022), an intriguing discovery emerged regarding the occurrence of Immobility-Associated Pressure Injuries (IAPI) among participants. Surprisingly, IAPI affected 18.0% of the participants, highlighting its significant prevalence in healthcare settings. While traditionally, women, individuals with chronic diseases, and those who underwent major surgery were considered at higher risk, the study found that this risk was somewhat mitigated in these populations. This unexpected finding challenges conventional assumptions and underscores the need for nuanced risk assessment and preventive strategies tailored to individual patient profiles [48].

In a pioneering study led by Kawther Badry Mobed et al. (2022), an insightful exploration into skin lesions unveiled intriguing findings. Among the various types of skin lesions, pressure ulcers emerged as the most prevalent, accounting for 40% of the reported cases. Furthermore, when examining the anatomical sites of injury, the sacral region stood out as the most commonly affected area, representing 40% of the cases. Notably, 30% of the cases exhibited lesions in more than one location, indicating the multifaceted nature of these injuries. These findings shed light on the distribution and characteristics of skin lesions, providing valuable insights for healthcare professionals to tailor preventive and management strategies effectively [31].

In an innovative study led by Gehan Abd Elfattah Atia Elasrag et al. (2022), a novel approach to skin integrity care demonstrated remarkable success in preventing pressure ulcer development among patients in the study group. The implementation of a comprehensive care bundle resulted in a striking outcome, with an impressive 90% of patients exhibiting either no pressure ulcers or no signs of pressure ulcer following the nursing intervention. This signifies a significant positive impact on patient outcomes and underscores the efficacy of tailored nursing interventions in preserving skin integrity and enhancing overall patient well-being [32].

In a compelling study by Doaa Mohamed Mahmoud et al. (2022), the assessment of pressure ulcer risk levels unveiled intriguing patterns. Within the control group, 56% of participants were identified as having a moderate risk, while 18% were classified as high risk. Interestingly, the study group exhibited similar trends, with 54% presenting moderate risk and 20% categorized as high risk. These findings suggest a comparable distribution of risk levels between the control and study groups, highlighting the need for targeted interventions to mitigate pressure ulcer risk across both cohorts [34].

In a groundbreaking study led by Ebtsam Saad Soliman et al. (2022), the implementation of evidence-based practice guidelines demonstrated a remarkable impact on patients’ outcomes regarding pressure ulcers. A statistically significant variation was observed between the study and control groups, indicating the efficacy of evidence-based practices in improving patient outcomes. This finding underscores the transformative potential of structured guidelines in enhancing healthcare delivery and highlights the importance of adhering to evidence-based approaches to optimize patient care [38].

In a groundbreaking study by E.S.S. Saad et al. (2022), the impact of a program implementation on participants’ knowledge and practice levels regarding a specific topic was evaluated. Remarkably, both immediate post-implementation and one-month follow-up assessments revealed statistically significant increases in total knowledge and practice level mean scores compared to pre-program levels. This signifies not only the effectiveness of the program but also the sustainability of its impact over time. These findings underscore the transformative potential of structured educational initiatives in fostering long-term improvements in knowledge and practice within healthcare settings [16].

In a thought-provoking study led by Fitri Anita et al. (2022), an examination of nurses’ knowledge and practices concerning pressure ulcers unveiled compelling insights. Prior to the implementation of the program, only a modest 22% of the studied nurses demonstrated a commendable level of proficiency in total knowledge and practice regarding pressure ulcers. This underscores the crucial need for targeted interventions to enhance healthcare professionals’ understanding and application of preventive measures. These findings serve as a catalyst for the development of tailored educational programs aimed at bridging gaps in knowledge and fostering improved patient care practices [40].

In a groundbreaking study by Masoud Hatefi et al. (2022), an innovative combination of interventions emerged as a potent strategy in mitigating the risk of injury. Through meticulous data analysis, it was revealed that the utilization of both an air cushion and positioning at a 30º angle resulted in a statistically significant reduction in injury risk, with a p-value of 0.035 (less than the conventional threshold of 0.05). This novel finding underscores the potential of synergistic approaches in enhancing patient safety and highlights the importance of exploring multifaceted interventions in healthcare settings [42].

In a pioneering study led by Fatma Magdi Ibrahim et al. (2022), an intriguing pattern emerged regarding the risk status of pressure ulcers among patients. The analysis revealed that a significant majority of patients attained scores indicating poor and low risk status. Specifically, the overall risk scores for pressure ulcers were distributed as follows: 12.7% fell within the low-risk category, 36.7% within moderate risk, 47.7% within high risk, and a mere 2.7% within the very high-risk category. This comprehensive assessment provides valuable insights into the varying degrees of risk among patients, underscoring the need for tailored preventive strategies to mitigate the occurrence and severity of pressure ulcers [44].

In a transformative study spearheaded by Amany El-berdan et al. (2022), the implementation of an educational film led to remarkable advancements in nursing practice and knowledge. Moreover, this innovative approach resulted in a tangible improvement in the wound healing process of pressure ulcers among older adults. This multifaceted outcome underscores the profound impact of educational interventions not only on healthcare professionals’ proficiency but also on the tangible health outcomes of patients. Such findings highlight the potential of multimedia educational tools to drive positive changes in clinical practice and patient care [45].

In an enlightening study conducted by Asmaa Nasr ELdin Mosbeh et al. (2022), the impact of a program on nurses’ knowledge and practices regarding pressure ulcers was unveiled. The findings illuminated a significant improvement post-program implementation, with both knowledge and practice levels showing a marked enhancement compared to pre-program levels. Importantly, the statistical analysis underscored the significance of these improvements, with a p-value less than 0.05 indicating the robustness of the observed changes. This highlights the transformative potential of structured educational initiatives in empowering healthcare professionals and elevating the quality of patient care [46].

In a compelling study led by Heba Mohamed Tawfik et al. (2022), an exploration into skin care practices in the Neonatal Intensive Care Unit (NICU) revealed intriguing findings. Despite a mean experience of 7.3 years among the nursing staff, the analysis unveiled a notable discrepancy in knowledge and practice levels. Surprisingly, more than one-third of the nurses exhibited a commendable level of total knowledge, while over half of them demonstrated incompetent total practice in skin care within the NICU setting. These insights shed light on the complex interplay between experience, knowledge acquisition, and practical application in specialized healthcare environments, underscoring the need for tailored interventions to bridge gaps and ensure optimal care for vulnerable neonates [49].

In an insightful study led by Despina Georgieva et al. (2022), the effectiveness of the BS in predicting pressure ulcer occurrence was thoroughly examined. The analysis revealed that the BS demonstrated high sensitivity in identifying individuals at risk, with a cutoff point of ≤ 17. Impressively, it exhibited a positive predictive value of 77.4%, indicating its ability to accurately predict the development of pressure ulcers. Equally noteworthy was its remarkable negative predictive value of 97.3%, highlighting its efficacy in ruling out the likelihood of pressure ulcer occurrence among individuals assessed as low risk. These findings underscore the invaluable role of the BS as a reliable tool for risk assessment in clinical practice, facilitating proactive measures to prevent pressure ulcers and optimize patient care [19].

In an insightful study led by Samia Gaballah et al. (2022), a comprehensive assessment of decubitus wound risk among respondents revealed compelling insights. Astonishingly, the majority of respondents, comprising 83%, were identified as being at significant risk of developing decubitus wounds. Furthermore, 26.67% were categorized as being at great risk, while 14.17% fell into the moderate risk category. Interestingly, only a small fraction, 8.33%, of all patients tested were deemed to be at light risk. These findings underscore the pervasive nature of decubitus wound risk and emphasize the importance of proactive preventive measures to mitigate its occurrence and impact on patient well-being [29].

In a groundbreaking study led by Mona Mohamed Mayhob et al. (2021), the impact of a program on nurses’ knowledge and practices concerning PI care was unveiled. Through meticulous analysis, it was found that post-program implementation, nurses exhibited a significant improvement in both knowledge and practices related to PI care compared to pre-program levels. This transformative outcome underscores the effectiveness of structured educational interventions in elevating healthcare standards and fostering proactive patient care. These findings serve as a testament to the ongoing commitment to continuous learning and improvement within healthcare settings [25].

In a compelling study led by Vanessa Leal de Lima de Moura et al. (2021), the implementation of a care bundle yielded promising results in pressure ulcer prevention. Remarkably, over half of the patients who received care following the care bundle elements did not develop pressure ulcers within four days, with a significant 52.5% showing no signs of pressure ulcer formation. This finding underscores the effectiveness of a structured and comprehensive approach to patient care, highlighting the potential impact of standardized protocols in reducing adverse outcomes and enhancing overall patient well-being [35].

In a study led by Edward, M.I. (2021) et al., an intriguing pattern emerged regarding the prevalence of nurse participation across different healthcare units. The data revealed that a significant proportion of nurses, comprising 29.63%, were actively engaged in ICUs, underscoring their crucial role in critical patient care settings. Additionally, a notable presence of nurses, accounting for 18.52%, was observed in hospitalization units, emphasizing their diverse contributions to patient care across various healthcare domains. These findings shed light on the dynamic and multifaceted nature of nursing roles within healthcare systems, highlighting the invaluable contributions of nurses in delivering quality care across different clinical settings [50].

In a thought-provoking study led by Pramila Baral et al. (2020), an intriguing discrepancy was uncovered between nurses’ knowledge and perception regarding the Braden score. While the majority of nurses demonstrated a commendable understanding of the Braden score, their perception towards its utility in predicting pressure ulcers was notably poor. This finding underscores the importance of not only educating healthcare professionals on assessment tools but also emphasizing the practical application and significance of these tools in clinical practice. It highlights the need for targeted interventions aimed at enhancing nurses’ perception and confidence in utilizing assessment scales to effectively identify and prevent pressure ulcers [51].

In a groundbreaking study led by Na, Hyung-Ju et al. (2020), an innovative analysis of the Braden scale’s reliability unveiled compelling insights. The Intraclass Correlation Coefficient (ICC) was reported as 0.85, indicating strong agreement among raters in total scores on the Braden scale. Moreover, the Proportional Odds (Po) ratio was calculated at 0.29, shedding light on the scale’s predictive power in assessing pressure ulcer risk across different severity levels. These findings underscore the robustness of the Braden scale as a reliable tool for evaluating pressure ulcer risk and emphasize its utility in clinical practice for effective risk assessment and preventive interventions [20].

In a comprehensive study led by AAbiru Neme et al. (2020), the prevalence and types of pressure ulcers among patients admitted to public hospitals were meticulously examined. Among the 356 patients assessed, a total of 56 individuals developed pressure ulcers, resulting in a prevalence rate of 15.7%. Of these pressure ulcers, 6 cases (1.7%) were attributed to Injuries MDRPI, while Routine Pressure Ulcers accounted for 34 cases (9.6%). Intriguingly, 16 cases (4.5%) were classified as other types of pressure ulcers. These findings provide valuable insights into the multifaceted nature of pressure ulcer etiology and emphasize the importance of targeted preventive measures to reduce their occurrence among hospitalized patients [22].

In a groundbreaking study led by Mona Mohamed Ibrahim et al. (2020), a profound connection was unveiled between the implementation of a pressure ulcer educational protocol and nurses’ knowledge, attitude, and practice towards Pressure injury prevention. The results illuminated a positive association, indicating that the educational intervention had a significant impact on enhancing nurses’ understanding, mindset, and implementation of preventive measures for pressure ulcers within ward settings. This transformative finding underscores the pivotal role of structured educational initiatives in empowering healthcare professionals and driving positive changes in patient care practices. It highlights the potential of education as a catalyst for improving healthcare outcomes and underscores the importance of ongoing professional development in enhancing quality of care [35].

In a pivotal study spearheaded by Manal Tharwat AbouZaid et al. (2020), the impact of implementing a wound care protocol on nurses’ practice was investigated, yielding transformative results. The findings unveiled a statistically significant improvement in nurses’ practice regarding wound care post-implementation of the protocol, with p-values of 0.014 and 0.000, respectively. This marked enhancement underscores the effectiveness of structured protocols in empowering healthcare professionals to deliver high-quality wound care. The study highlights the critical role of standardized protocols in standardizing practice, enhancing patient outcomes, and fostering a culture of excellence in healthcare delivery [39] (Table 2).