Knowledge, attitudes, and practices of Chinese NICU nurses regarding the prevention of medical device-related pressure injuries: A cross-sectional study.
TL;DR
In this multicenter convenience sample, Chinese NICU nurses reported positive attitudes and frequent self-reported preventive practices, whereas self-reported Knowledge scores were comparatively lower, especially for MDRPI staging and standardized assessment.
Abstract
Background
Medical device-related pressure injuries (MDRPIs) are a major patient-safety concern in neonatal intensive care units (NICUs). Nurses play a pivotal role in prevention, yet their knowledge, attitude, and practice (KAP) regarding MDRPI prevention remain insufficiently understood. This multicenter cross-sectional study aimed to evaluate MDRPI-prevention KAP among Chinese NICU nurses and identify associated individual- and hospital-level factors.
Methods
Using convenience sampling, we conducted a multicenter cross-sectional survey of registered NICU nurses across 22 provinces of China from September 2025 to March 2026. Participants completed a validated 38-item self-reported KAP questionnaire and two open-ended questions through an online platform. Null-model intraclass correlation coefficients (ICCs) were estimated to assess between-hospital clustering. Knowledge scores were analyzed using ordinary multiple linear regression because the null-model ICC was approximately 0, whereas Attitude, Practice, and total KAP scores were analyzed using hospital-level random-intercept models. Individual-level, institutional-level, and combined models were compared using the Akaike Information Criterion (AIC). Responses to the open-ended questions were summarized using structured content analysis and keyword-frequency counting.
Results
The final sample included 472 nurses from 135 hospitals. The percentages of maximum possible scores were 71.2% for self-reported Knowledge, 89.7% for Attitude, and 88.9% for Practice. The individual-level model had the lowest AIC for all outcomes. MDRPI-related training was the individual-level factor most consistently associated with KAP scores. Previous MDRPI management experience was associated with higher Knowledge, Attitude, and total KAP scores, and longer NICU experience was associated with higher self-reported Practice scores. In models that included hospital-level descriptors, hospital type, hospital level, and teaching hospital status were not independently associated with KAP scores. In open-ended responses, nasal CPAP prongs/cannula (46.8%), mechanical ventilators (45.1%), and peripheral intravenous catheters (36.4%) were most frequently perceived as high-risk devices. Hydrocolloid dressings (37.7%) and the high-lift and flat-placement method (15.3%) were the most frequently reported prevention strategies.
Conclusions
In this multicenter convenience sample, Chinese NICU nurses reported positive attitudes and frequent self-reported preventive practices, whereas self-reported Knowledge scores were comparatively lower, especially for MDRPI staging and standardized assessment. Structured, device-specific education and experiential learning may strengthen prevention capacity. Future observational and interventional studies should test whether KAP improvements translate into better observed adherence and lower neonatal MDRPI incidence.